Data from patients hospitalised with Crohn’s disease (CD) between 1998 and 2000 in Scotland indicate higher 3-year mortality rates than the general population. (1) We now have the opportunity of comparing these data with contemporary mortality data in patients admitted in Scotland between 2007–2009. We hypothesised key alterations in management of CD over the last decade may have reduced mortality.Methods
The Scottish Morbidity Records and linked datasets were used to assess 3-year crude 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. Age-standardised mortality rates (ASR) were used to compare mortality rates between periods.Results
The number of patients hospitalised for 4 or more days with CD was 1460 [Period 1] to 1565 [Period 2] (15.6 to 14.5 per 100,000 Scottish population per year). There was no change in the crude or adjusted 3-year mortality rate between study periods (crude 9.0% to 9.1%, adjusted OR = 0.87 CI: 0.65–1.17; p = 0.355). In subgroup analysis, the adjusted 3-year mortality increased following elective surgery (OR 13.5, CI: 1.66 – 109.99) and decreased following emergency medical admission (OR = 0.68, CI: 0.47–0.97).Results
The directly age-standardised mortality rates (ASR) per 10,000 person years were unchanged between study periods ([Period 1 ASR 299, CI: 251–348][Period 2 ASR 281, CI: 233–328]).Results
On multivariate analysis, age, deprivation status, co-morbidity, and hospital length of stay were associated with increased 3-year mortality in both study periods.Conclusion
The overall mortality after hospitalisation for CD has not altered, although mortality associated with emergency medical admission has decreased, and now does not differ from rates after emergency surgical admission.Reference
1 Kennedy NA, Clark DN, Bauer J, et al. Nationwide linkage analysis in Scotland to assess mortality following hospital admission for Crohn’s disease: 1998–2000. Aliment Pharmacol Ther 2012;35:142–53Disclosure of Interest
N. Ventham: None Declared, N. Kennedy: None Declared, A. Duffy: None Declared, D. Clark: None Declared, A. Crowe: None Declared, A. Knight: None Declared, J. Nicholls Grant/research support from: A grant was obtained from AbbVie Ltd to be administered by the North West London Hospital Trust (NWLHT) on behalf of Prof Nicholls, to allow funding of ISD and Corvus Communications for their work on the project. In the context of the work presented in this manuscript and in consideration of BMJ guidance, none of the authors have any competing or other conflict of interest, J. Satsangi: None Declared.