Inflammatory Bowel Disease (IBD), which consists of Crohn's disease (CD) and ulcerative colitis (UC), affects over 1.4 million Americans. Although the morbidities associated with IBD are well known, the mortality data is conflicting, with some studies demonstrating no increased risk and others showing a substantially increased risk of death in IBD patients. Most of these aforementioned studies do not take into account the advancements made in the treatment of IBD over recent years. In particular, the mortality effect of anti-TNF agents, such as infliximab, which was FDA approved for CD in 1998 and later for UC in 2005, remains unclear. Thus the overall aim of this study is to investigate the age and cause of death among those with IBD as compared to the general population, and to determine whether the introduction of anti-TNF therapy has had any effect on the cause of mortality in patients with IBD.Methods:
A death certificate based case-control study was performed to explore the mortality risk among those with IBD. Cases consisted of 1970 patients with IBD (1129 with CD and 841 with UC) who died in New York State from 1993 to 2010. Controls were randomly chosen from those who died in New York State in the same time frame, without a diagnosis of IBD. Cause of death was based on ICD codes listed on the death certificate. Each case was matched with 4 controls by sex and zip code, with a total of 7880 controls. Odd ratios with 95% confidence intervals were estimated by conditional logistic regression.Results:
Compared with matched controls, those with IBD were more likely to die prematurely (age < 65 yr) (OR 1.26, CI 95%, 1.119–1.421, P = 0.001). Similarly, those with IBD were also more likely to die from a gastrointestinal cause (OR 16, 95% CI, 13.57–19.098, P < 0.001), as compared to the general population. The leading cause of death in those with IBD was gastrointestinal disease (36.3%), primarily septic complications of their IBD, followed by cardiovascular disease (25.0%) and cancer (14.4%). In contrast, the main causes of death among those in the general population were cardiovascular disease (41.5%), cancer (24.1%), and diseases of the respiratory system (9.9%). The most common cancers in the IBD group were colon (22%), lung (15%), and prostate cancer (3%), while in the controls, lung (29%), breast (8%) and colon cancer (8%) were the most prevalent. In the sub-analysis, there was no significant difference in the cause or age of death before and after the introduction of anti-TNF agents in those with CD (70.8 versus 71.1 yr, P = 0.7048) or UC (75.0 versus 76.1 yr, P = 0.2946).Conclusions:
IBD patients who died in New York State from 1993 to 2010 had increased odds of premature death and were more likely to die from of a gastrointestinal cause, as compared to sex and zip code matched controls. There was no significant difference in the age or cause of death in this population when comparing the period before and after the introduction of anti-TNF therapy.