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Cause-Specific Mortality and 30-year Relative Survival of Crohn's Disease and Ulcerative Colitis

Selinger, Christian P. MSc, MD, MRCP*,†; Andrews, Jane MBBS, PhD, FRACP; Dent, Owen F. PhD*,§; Norton, Ian MBBS, PhD, FRACP; Jones, Brian MD, FRACP, FRCP, FACG*; McDonald, Charles MBBS, FRACP*; Cowlishaw, James MBBS, FRACP*; Barr, Gavin MBBS, FRACP*; Selby, Warwick MBBS, MD, FRACP; Leong, Rupert W. MBBS, MD, FRACP*,**; on behalf of the Sydney IBD Cohort Study Group

doi: 10.1097/MIB.0b013e31829080a8
Original Clinical Articles

Background: Data from the northern hemisphere suggest that patients with ulcerative colitis (UC) have similar survival to the general population, whereas mortality in Crohn's disease (CD) is increased by up to 50%. There is a paucity of data from the southern hemisphere, especially in Australia.

Methods: A prevalence cohort (1977–1992) of patients with inflammatory bowel disease (IBD) diagnosed after 1970 was studied. Survival status data and causes of death up to December 2010 were extracted from the National Death Index. Relative survival analysis was carried out separately for men and women.

Results: Of 816 cases (384 men, 432 women; 373 CD, 401 UC, 42 indeterminate colitis), 211 (25.9%) had died by December 2010. Median follow-up was 22.2 years. Relative survival of all patients with IBD was not significantly different from the general population at 10, 20, and 30 years of follow-up. Separate analyses of survival in CD and UC also showed no differences from the general population. There was no difference in survival between patients diagnosed earlier (1971–1979) or later (1980–1992). At least 17% of the deaths were caused by IBD. Fatal cholangiocarcinomas were more common in IBD (P < 0.001), and fatal colorectal cancers more common in UC (P = 0.047).

Conclusions: In Australia, IBD patient survival is similar to the general population. In contrast to data from Europe and North America, survival in CD is not diminished in Australia. IBD caused direct mortality in 17%, especially as biliary and colorectal cancers are significant causes of death.

Article first published online 12 June 2013

*Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia;

Department of Gastroenterology, Salford Royal Hospital, Salford, United Kingdom;

IBD Service, Department of Gastroenterology & Hepatology and School of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia;

§Sydney Medical School, University of Sydney, Sydney, Australia;

Department of Gastroenterology, Royal North Shore Hospital, Sydney, Australia;

AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia; and

**Faculty of Medicine, University of New South Wales, Sydney, Australia.

Reprints: Christian P. Selinger, MSc, MD, MRCP, Department of Gastroenterology, Salford Royal Hospital, Stott Lane, Salford M6 8HD, United Kingdom (e-mail: christian.selinger@web.de).

R. W. Leong was partly funded by a National Health and Medical Research Council of Australia Career Development Award. The other authors have no conflicts of interest to disclose.

Received December 18, 2012

Accepted March 05, 2013

© Crohn's & Colitis Foundation of America, Inc.
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