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In-hospital deaths declined among patients with ulcerative colitis
Incidence of in-hospital mortality among patients with ulcerative colitis decreased consistently during a 13-year period in a recent study.
Researchers evaluated the in-hospital mortality rates of 17,393 patients with IBD hospitalized between 1994 and 2006. The data were collected from the National Hospital Discharge Survey, and results were divided into three-year periods: 1994 to 1996, 1997 to 1999, 2000 to 2002 and 2003 to 2006.
In-hospital death occurred in 150 (0.9%) IBD patients, including 71 with Crohn’s disease and 79 with ulcerative colitis. After adjusting for age, the incidence of mortality decreased from 3.6 deaths per 1,000 hospital days between 1994 and 1996 to 2.4 per 1,000 days between 2003 and 2006. The standardized mortality ratio also decreased from 0.33 to 0.27 between these periods.
Patients with ulcerative colitis experienced similar decreases: Mortality incidence per 1,000 hospital days decreased from 4.1 in 1994-1996 to 2.8 in 2003-2006, and the standardized mortality ratio decreased from 0.49 to 0.35. No change was found in in-hospital mortality rates during the entire period among patients with Crohn’s disease. Investigators also found that patients with ulcerative colitis were twice as likely to die in-hospital as those with Crohn’s disease (1.3% of patients compared with 0.6%, P<.001).
A 17% reduction in the odds for in-hospital mortality per three-year period was established via multivariate analysis (OR=0.83, P=.012). Factors associated with hospital death included a patient’s age, per year (OR=1.06, P<.001), their score on the Charlson comorbidity index (OR=1.29 for each 1-point increase, P<.001), and ulcerative colitis diagnosis (OR=1.41 vs. Crohn’s disease, P=.042). Among patients with ulcerative colitis, researchers observed a 20% decrease in mortality odds per time period (OR=0.80, P=.02).
“It is likely that numerous factors contribute to the mortality trends that we document,” the researchers wrote. “Importantly, though, our analyses argue against confounding by changing age, comorbidity or hospitalization practices. … Much of what we know about the course of IBD is drawn from cohorts that, while well-characterized, are not nationally representative. This limits understanding of changes in IBD course over time at a population level, and underscores the need for prospectively collected, nationally representative, ambulatory data in IBD.”