Comparison of mortality following hospitalisation for ulcerative colitis in Scotland between 1998–2000 and 2007–2009

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Abstract

Background

Scottish nationwide linkage data from 1998 to 2000 demonstrated high 3-year mortality in patients hospitalised with ulcerative colitis (UC).

Aim

To compare 3-year mortality, and factors related to mortality, in Scottish patients hospitalised with UC between 1998–2000 and 2007–2009.

Methods

The Scottish Morbidity Records and linked datasets were used to assess 3-year mortality, standardised mortality ratio (SMR) and multivariate analyses of factors associated with 3-year mortality. The 3-year mortality was determined after four admission types: surgery-elective or emergency; medical-elective or emergency.

Methods

Age-standardised mortality rates (ASR) were used to compare mortality rates between periods.

Results

Ulcerative colitis admissions increased from 10.6 in Period 1 to 11.6 per 100 000 population per year in Period 2 (P= 0.046). Crude and adjusted 3-year mortality fell between time periods (crude 12.2% to 8.3%; adjusted OR 0.59, CI 0.42–0.81, P= 0.04). Adjusted 3-year mortality following emergency medical admission (OR 0.58, CI 0.39–0.87, P= 0.003) and in patients >65 years (38.8% to 28.7%, P= 0.02) was lower in Period 2. The SMR in period 1 was 3.04 and 2.96 in Period 2. Directly age-standardised mortality decreased from 373 (CI 309–437) to 264 (CI 212–316) per 10 000 person-years. On multivariate analysis, increasing age (50–64 years OR 7.11 (CI 2.77–18.27, P < 0.05); 65–74 years OR 14.70 (CI 5.65–38.25 P < 0.05); >75 years OR 46.42 (CI 18.29–117.78, P < 0.001) and co-morbidity (OR 3.02, CI 1.72–5.28, P < 0.001) were significantly associated with 3-year mortality in Period 2.

Conclusions

Comparisons of crude and adjusted mortality rates suggest significant improvement in outcome over the last decade – however, mortality remains high, and older age and co-morbidity are important predictors of outcome.

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