Childhood onset inflammatory bowel disease linked to higher mortality risk

Takeaway

• Risk for mortality was 3-fold higher in patients with childhood-onset inflammatory bowel diseases (IBD) compared with healthy children from general population.
• The highest risk was observed in patients with childhood-onset ulcerative colitis, Crohn’s disease and IBD-unclassified.
• The relative mortality did not seem to decrease over time.

Why this matters

• Patients with childhood-onset IBD may need close monitoring for disease activity and malignancy.

Study design

• Study evaluated children with IBD (aged <18 years) from the Swedish nationwide health registers (1964-2014; n=9442) and matched individuals from the general population (reference group; n=93,180).
• Funding: Stockholm County Council and Karolinska Institutet (ALF), the Swedish Cancer Society, the Swedish Research Council, and the Swedish Foundation for Strategic Research.   

Key results                                                                                             

• 138,690 person-years of follow-up.
• Mean age at end of follow-up was 30 years.
• 294 deaths were reported in the patients with IBD vs 940 deaths in the reference group.
• Incidence of death was significantly higher in patients with IBD vs reference group (2.1 vs 0.7 deaths per 1000 person-years; adjusted HR, 3.2; 95% CI, 2.8-3.6).
• Risk for death was significantly higher in patients with:
  • ulcerative colitis (HR, 4.0; 95% CI, 3.4-4.7),
  • Crohn’s disease (HR, 2.3; 95% CI, 1.8-2.9) and
  • IBD unclassified (HR, 2.0; 95% CI, 1.2-3.4).
• Among patients aged <18 years, 27 deaths from IBD were reported (HR, 4.9; 95% CI, 3.0-7.7).
• The incidence of death remained stable in young adults during 1964-2014 (P=.90).

Limitations

• Study was underpowered to directly assess the effect of immunomodulators and biologics on mortality.