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Mortality of Patients With Microscopic Colitis in Sweden
Hamed Khalili1, David Bergman2, Bjorn Roelstraete2
1Crohn's and Colitis Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Background & Aims:
Microscopic colitis is one of the most common causes of chronic diarrhea in older populations. We investigated all-cause and cause-specific mortality in patients with microscopic colitis.
Methods:
We conducted a nationwide cohort study of all cases of microscopic colitis (n = 14,333) diagnosed from 1990 through 2017 in Sweden. Cases of microscopic colitis were identified using SNOMED codes from gastrointestinal histopathology reports collected from Sweden's 28 pathology departments. Each case of microscopic colitis was matched to 5 population comparators (n = 68,700). Mortality data were ascertained from Sweden's cause of death register. We used Cox proportional hazards modeling to estimate adjusted hazard ratios (aHRs) and 95% CIs.
Results:
Through December of 2017, we confirmed 3014 deaths in patients with microscopic colitis (27.4/1000 person-years) and 12,534 deaths in matched population comparators (23.3/1000 person-years). This corresponded to a 10-year absolute risk difference of 3.4% (95% CI, 2.1%-4.6%) and an aHR of 1.17 (95% CI, 1.12-1.22). However, further adjustment of models for comorbidity burden reduced the relative risk of death for patients with microscopic colitis (aHR, 0.98; 95% CI, 0.94-1.02). In analyses of cause-specific death, microscopic colitis was associated with an increased risk of gastrointestinal-related death (aHR, 1.68; 95% CI, 1.38-2.05) and infection-related death (aHR, 1.42 ; 95% CI, 1.11-1.83), but not cancer-related death (aHR, 0.83; 95% CI, 0.76-0.91) or cardiovascular-related death (aHR, 1.02; 95% CI, 0.96-1.10).
Conclusions:
In a nationwide cohort study in Sweden, we found that patients with microscopic colitis were at increased risk of death. However, the increase appears to be related to higher burden of comorbidities in this population.
Insights
Microscopic colitis patients face increased mortality risk, primarily due to higher comorbidity burdens, not the condition itself. This finding impacts understanding of chronic diarrhea causes in older adults.
Area of Science:
- Gastroenterology
- Epidemiology
- Public Health
Background:
- Microscopic colitis is a leading cause of chronic diarrhea, particularly in elderly individuals.
- Understanding the mortality risks associated with microscopic colitis is crucial for patient management.
Purpose of the Study:
- To investigate all-cause and cause-specific mortality in patients diagnosed with microscopic colitis.
- To determine if microscopic colitis itself, or associated comorbidities, contributes to increased mortality.
Main Methods:
- A nationwide cohort study in Sweden included 14,333 microscopic colitis patients and 68,700 matched controls.
- Data were collected from 1990-2017, utilizing SNOMED codes and national mortality registers.
- Cox proportional hazards modeling was employed to analyze mortality risks.
Main Results:
- Patients with microscopic colitis had a slightly elevated overall mortality risk (aHR 1.17), which diminished after adjusting for comorbidities (aHR 0.98).
- Increased risks were observed for gastrointestinal (aHR 1.68) and infection-related deaths (aHR 1.42).
- No significant increase in cancer-related or cardiovascular-related death risks was found.
Conclusions:
- While microscopic colitis patients show a higher initial mortality risk, this is largely explained by their greater comorbidity burden.
- The study highlights the importance of considering comorbidities when assessing mortality in microscopic colitis patients.
