Increased Mortality of Patients With Childhood-Onset Inflammatory Bowel Diseases, Compared With the
Ola Olén1, Johan Askling2, Michael C Sachs3
1Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Insights
Children diagnosed with inflammatory bowel disease (IBD) face a threefold increased mortality risk into adulthood. This elevated risk for childhood-onset IBD persists despite advancements in treatment, highlighting a critical unmet need.
Area of Science:
- Gastroenterology
- Pediatrics
- Epidemiology
Background:
- Childhood-onset inflammatory bowel disease (IBD) is often considered more severe than adult-onset IBD.
- Limited data exists on all-cause and cause-specific mortality in pediatric IBD patients.
- This study investigates long-term mortality risks in individuals diagnosed with IBD before age 18.
Purpose of the Study:
- To estimate the absolute and relative risks of all-cause and cause-specific mortality.
- To analyze mortality risks in childhood-onset IBD patients throughout childhood and adulthood.
- To assess trends in mortality risk over a 50-year period.
Main Methods:
- Population-based cohort study using Swedish nationwide health registers (1964-2014).
- Identified 9,442 children with IBD (under 18) and matched them with 93,180 controls.
- Utilized Cox regression to estimate hazard ratios (HR) for mortality in ulcerative colitis, Crohn's disease, and IBD unclassified.
Main Results:
- Patients with childhood-onset IBD had a 3.2-fold increased risk of death (adjusted HR) compared to controls.
- Increased mortality risks were observed for ulcerative colitis (HR 4.0), Crohn's disease (HR 2.3), and IBD unclassified (HR 2.0).
- Mortality risk among young adults with IBD showed no significant decrease between 1964 and 2014.
Conclusions:
- Childhood-onset IBD is associated with a significantly elevated risk of death persisting into adulthood.
- The relative risk of mortality for these patients has not diminished with therapeutic advancements.
- These findings underscore the long-term severity and mortality implications of pediatric IBD.
Background & Aims:
Childhood-onset inflammatory bowel disease (IBD) is believed to be a more severe disease than adult-onset IBD, but there is little information on all-cause and cause-specific mortality in patients with childhood-onset IBD. We performed a population-based cohort study, with 50 years of follow-up, to estimate absolute and relative risks for overall and cause-specific mortality in patients with childhood-onset IBD, during childhood and adulthood.
Methods:
We identified children with a diagnosis of IBD (younger than 18 years) in the Swedish nationwide health registers (1964-2014; n = 9442) and individuals from the general population matched for sex, age, calendar year, and place of residence (reference group; n = 93,180). Hazard ratios (HR) for death were estimated using Cox regression separately in patients with ulcerative colitis (n = 4671), Crohn's disease (n = 3780), and IBD unclassified (n = 991). HRs were compared among calendar periods.
Results:
During 138,690 person-years of follow-up, 294 deaths (2.1/1000 person-years) occurred among the patients with IBD compared with 940 deaths in the reference group (0.7/1000 person-years; adjusted HR, 3.2; 95% confidence interval [CI] 2.8-3.7). Mean age at end of follow-up was 30 years. HRs were increased for patients with ulcerative colitis 4.0, 95% CI 3.4-4.7; Crohn's disease 2.3, 95% CI 1.8-3.0; and IBD unclassified 2.0, 95% CI 1.2-3.4. Among patients younger than 18 years, there were 27 deaths from IBD 4.9, 95% CI 3.0-7.7. Among young adults with IBD, we found no evidence that HRs for death decreased from 1964 through 2014 (P = .90).
Conclusions:
Children with IBD have a 3-fold increase in risk of death when followed through adulthood. The relative risk for death has not decreased with development of new drugs for treatment of IBD.
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