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Comparison of mortality following hospitalisation for ulcerative colitis in Scotland between 1998–2000 and 2007–2009
Author(s) -
Ventham N. T.,
Kennedy N. A.,
Duffy A.,
Clark D. N.,
Crowe A. M.,
Knight A. D.,
Nicholls R. J.,
Satsangi J.
Publication year - 2014
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12750
Subject(s) - medicine , ulcerative colitis , mortality rate , multivariate analysis , population , standardized mortality ratio , pediatrics , demography , disease , environmental health , sociology
Summary Background Scottish nationwide linkage data from 1998 to 2000 demonstrated high 3‐year mortality in patients hospitalised with ulcerative colitis ( UC ). Aim To compare 3‐year mortality, and factors related to mortality, in Scottish patients hospitalised with UC between 1998–2000 and 2007–2009. Methods The Scottish Morbidity Records and linked datasets were used to assess 3‐year 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 Ulcerative colitis admissions increased from 10.6 in Period 1 to 11.6 per 100 000 population per year in Period 2 ( P = 0.046). Crude and adjusted 3‐year mortality fell between time periods (crude 12.2% to 8.3%; adjusted OR 0.59, CI 0.42–0.81, P = 0.04). Adjusted 3‐year mortality following emergency medical admission ( OR 0.58, CI 0.39–0.87, P = 0.003) and in patients >65 years (38.8% to 28.7%, P = 0.02) was lower in Period 2. The SMR in period 1 was 3.04 and 2.96 in Period 2. Directly age‐standardised mortality decreased from 373 ( CI 309–437) to 264 ( CI 212–316) per 10 000 person‐years. On multivariate analysis, increasing age (50–64 years OR 7.11 ( CI 2.77–18.27, P < 0.05); 65–74 years OR 14.70 ( CI 5.65–38.25 P < 0.05); >75 years OR 46.42 ( CI 18.29–117.78, P < 0.001) and co‐morbidity ( OR 3.02, CI 1.72–5.28, P < 0.001) were significantly associated with 3‐year mortality in Period 2. Conclusions Comparisons of crude and adjusted mortality rates suggest significant improvement in outcome over the last decade – however, mortality remains high, and older age and co‐morbidity are important predictors of outcome.