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All-cause and cause-specific mortality in microscopic colitis: a Danish nationwide matched cohort study
Nynne Nyboe Andersen1, Lars Kristian Munck2,3, Susanne Hansen4
1Department of Medical Gastroenterology and Hepatology, Rigshospitalet, Copenhagen, Denmark.
Background:
The long-term natural history of microscopic colitis remains uncertain.
Aim:
To describe the mortality in a large unselected cohort of patients with microscopic colitis.
Methods:
All Danish patients above 18 years with an incident diagnosis of microscopic colitis from 2001 to 2018 were identified from nationwide registries and compared to age- and sex-matched controls (variable 1:10 ratio). Patients were categorised according to subtypes: lymphocytic colitis and collagenous colitis. The relative risk of death by any cause was analysed with Cox regression models estimating both crude and comorbidity-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Cause-specific death was evaluated with cumulative incidence functions. An E-value was calculated to address the impact of unmeasured confounding.
Results:
The final cohort consisted of 14 024 patients with microscopic colitis. The mean follow-up was 5.8 (standard deviation SD, 2.9) years and the mean age at diagnosis was 61.1 (SD 13.9) years, 70% were women and 41% were diagnosed with lymphocytic colitis. The main results showed a 25% increased risk of all-cause death in patients with microscopic colitis; however, the relative risk was attenuated to 9% when adjusting for comorbidities (95% CI, 1.05-1.14). The E-value indicates that unmeasured confounding could explain the residual observed increased all-cause mortality. Mortality was significantly increased in patients with both lymphocytic colitis (HR 1.15; 95% CI, 1.08-1.23) and collagenous colitis (HR 1.06; 95% CI, 1.01-1.12) in fully adjusted analyses. The absolute difference in death between patients with microscopic colitis and matches was 0.9% at 1 year, 2.8% at 5 years, 5.0% at 10 years and 3.0% at 15 years. Cumulative incidence functions showed that patients with microscopic colitis were more likely to die due to smoking-related diseases including ischemic heart and lung diseases, but had a significant decreased risk of death due to colorectal cancers (P < 0.0001).
Conclusion:
In an unselected large nationwide cohort of patients with microscopic colitis, the risk of death was significantly increased compared to the background population. However, the increased mortality seemed to be associated to a high burden of comorbidities and unmeasured life-style factors including smoking and not microscopic colitis per se.
Insights
Microscopic colitis patients face a higher mortality risk, primarily linked to comorbidities and lifestyle factors like smoking, not the condition itself. This large nationwide study highlights the need to address these associated risks for better patient outcomes.
Area of Science:
- Gastroenterology
- Epidemiology
- Public Health
Background:
- The long-term prognosis and mortality associated with microscopic colitis are not well-established.
- Understanding the natural history of microscopic colitis is crucial for patient management and public health initiatives.
Purpose of the Study:
- To investigate the all-cause and cause-specific mortality in a large, unselected cohort of Danish patients diagnosed with microscopic colitis.
- To compare the mortality rates of microscopic colitis patients with age- and sex-matched controls from the general population.
Main Methods:
- A nationwide cohort study identified 14,024 Danish patients with incident microscopic colitis (2001-2018).
- Patients were compared to a 1:10 ratio of matched controls, with analyses stratified by subtype (lymphocytic colitis, collagenous colitis).
- Cox regression models and cumulative incidence functions were used to analyze mortality, adjusting for comorbidities and calculating E-values for unmeasured confounding.
Main Results:
- Microscopic colitis patients exhibited a 25% increased risk of all-cause death, reduced to 9% after adjusting for comorbidities.
- Significant increases in mortality were observed for both lymphocytic colitis and collagenous colitis subtypes.
- Increased mortality was linked to smoking-related diseases, while colorectal cancer mortality risk decreased.
Conclusions:
- The elevated mortality risk in microscopic colitis patients is largely attributable to comorbidities and lifestyle factors, such as smoking, rather than the disease itself.
- While microscopic colitis is associated with increased mortality, interventions targeting comorbidities and lifestyle modifications are essential.
- Further research into unmeasured confounding factors is warranted to fully elucidate the mortality risks.
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