Crohn's disease-specific mortality: a 30-year cohort study at a tertiary referral center in Japan

J Gastroenterol. 2019 Jan;54(1):42-52. doi: 10.1007/s00535-018-1482-y. Epub 2018 Jun 9.

Abstract

Background: In this study, survival and cause of death were investigated in patients with Crohn's disease (CD) at a tertiary referral center.

Methods: A database was created based on the medical records of 1108 CD patients who had a history of visiting our hospital to investigate background characteristics, cumulative survival rates from diagnosis, causes of death, and the standardized mortality ratio (SMR) for each cause of death. A follow-up questionnaire survey of patients followed up inadequately was also conducted. The cumulative survival rate from diagnosis was determined using the life table method and compared with that of a sex- and age-matched population model from the year 2000.

Results: The study included 1108 patients whose mean age at diagnosis was 25.6 ± 10.8 years. The mean duration of follow-up was 14.6 ± 9.4 years, and there were 52 deaths. The cumulative survival rate was significantly lower 25 years after the diagnosis of CD (91.7%) than in the standard population model (95.7%). SMRs for both all causes [3.5; 95% confidence interval (CI): 2.7-4.6] and CD-specific causes (36.7; 95% CI 26.1-51.6) were high. Among the CD-specific causes, SMRs were especially high for small intestine and colorectal cancers, gastrointestinal diseases including intestinal failure (IF), perioperative complications, and amyloidosis.

Conclusion: The SMRs for both all causes and CD-specific causes were high in CD patients. CD-specific causes including intestinal cancer, IF, perioperative complications, and amyloidosis showed especially high SMRs.

Keywords: Amyloidosis; Cohort study; Crohn’s disease-specific mortality; Intestinal cancer; Standardized mortality ratios.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Cohort Studies
  • Colorectal Neoplasms / epidemiology*
  • Crohn Disease / epidemiology
  • Crohn Disease / mortality*
  • Female
  • Follow-Up Studies
  • Gastrointestinal Diseases / epidemiology*
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Retrospective Studies
  • Surveys and Questionnaires
  • Survival Rate
  • Tertiary Care Centers
  • Young Adult