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Cumulative Incidence and Risk Factors for Hospitalization and Surgery in a Population-based Cohort of Ulcerative Colitis

Samuel, Sunil MBBS, PhD*; Ingle, Steven B. MD*; Dhillon, Shamina MD*; Yadav, Siddhant MD*; Harmsen, W. Scott MS; Zinsmeister, Alan R. PhD; Tremaine, William J. MD*; Sandborn, William J. MD*,‡; Loftus, Edward V. Jr MD*

doi: 10.1097/MIB.0b013e31828c84c5
Original Clinical Articles

Background: We sought to identify clinical and demographic features influencing hospitalization and colectomy in a population-based inception cohort of ulcerative colitis.

Methods: Between 1970 and 2004, a total of 369 patients (58.5% males) from Olmsted County, MN, were followed from diagnosis for 5401 person-years. The cumulative probability of hospitalization and colectomy were estimated using the Kaplan–Meier method. Cox proportional hazards regression was used to identify factors associated with hospitalization and colectomy.

Results: The cumulative probability of first hospitalization was 29.4% at 5 years (95% confidence interval [CI], 24.5%–34.1%), 38.7% at 10 years (33.1%–43.8%), 49.2% at 20 years (42.7%–55.2%), and 52.3% at 30 years (45.1%–59.7%). The incidence rate of hospitalizations decreased over the last 4 decades, although cumulative probability of first hospitalization increased with successive decades of diagnosis. Early need for corticosteroids (hazard ratio [HR], 1.8; 95% CI, 1.1%–2.7%) and early need for hospitalization (HR, 1.5; 95% CI, 1.02–2.4) were independent predictors of hospitalization after 90 days of illness. The cumulative probability of colectomy from the time of diagnosis was 13.1% at 5 years (95% CI, 9.4%–16.6%), 18.9% at 10 years (95% CI, 14.4%–23.2%), and 25.4% at 20 years (95% CI, 19.8%–30.8%). Male gender (HR, 2.1; 95% CI, 1.3–3.5), diagnosis in the 1990s (HR, 2.0; 95% CI, 1.01–4.0), and diagnosis in 2000 to 2004 (HR, 3.7; 95% CI, 1.7–8.2) were significantly associated with colectomy risk.

Conclusions: Colectomy rates were comparable to reports from northern Europe. The numbers of hospitalizations show a decreasing trend. Male gender and being diagnosed in the 2000 to 2004 period predicted colectomy while extensive colitis predicted future hospitalizations.

Article first published online 8 May 2013

*Division of Gastroenterology and Hepatology and

Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; and

Division of Gastroenterology, University of California San Diego, La Jolla, California.

Reprints: Edward V. Loftus Jr, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905 (e-mail:

Supported in part by Schering-Plough and the Mayo Foundation for Medical Education & Research and made possible by the Rochester Epidemiology Project (grant number R01 AG034676 from the National Institute on Aging). E. V. Loftus has received research support from and has consulted (fees to Mayo) for Schering-Plough (now Merck). W. J. Sandborn has received research support from, consulted for, and participated in continuing medical education events indirectly sponsored by Schering-Plough (now Merck).

The authors have no financial or conflicts of interest to disclose.

This study was approved by the Institutional Review Boards of Mayo Clinic and Olmsted Medical Center.

Presented in part at the 70th Annual Meeting of the American College of Gastroenterology, Honolulu, Hawaii [Am J Gastroenterol. 2005;100(9 suppl):S303] and the 72nd Annual Meeting of the American College of Gastroenterology, Philadelphia, Pennsylvania (Am J Gastroenterol. 2007;102:S480–S481).

Received January 01, 2013

Accepted February 9, 2013

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