Gastroenterology. 2007 Dec;133(6):1779-86. Epub 2007 Sep 26.

Mortality by medication use among patients with inflammatory bowel
disease, 1996-2003.

Hutfless SM, Weng X, Liu L, Allison J, Herrinton LJ.

Epidemiology Department, Harvard School of Public Health, Boston,
Massachusetts, USA.

BACKGROUND & AIMS: Most previous population-based studies of mortality in
inflammatory bowel disease (IBD) did not account for medication use. We
evaluated mortality by IBD medication use among members of the Kaiser
Permanente Northern California IBD Registry. METHODS: The retrospective,
population-based cohort study included 9032 persons who received at least
one inpatient or 2 outpatient diagnoses of IBD during 1996-2002. Age and
sex standardized mortality ratios measured the associations between IBD
and all-cause and cause-specific mortality. Age, sex, and smoking adjusted
odds ratios measured the association of mortality by IBD medication use.
RESULTS: Compared with health plan members without IBD, mortality was
increased in patients with Crohn's disease (CD) (1.4; 95% confidence
interval, 1.2-1.6) but not ulcerative colitis (UC) (1.0; 95% CI, 0.9-1.2).
CD was associated with increased mortality from infectious and parasitic
diseases (4.1; 95% CI, 1.7-8.5), septicemia (6.8; 95% CI, 2.2-15.8), small
intestinal cancer (48.1; 95% CI, 5.8-17.4), respiratory diseases (1.9; 95%
CI, 1.3-2.7), digestive diseases other than IBD (2.4; 95% CI, 1.0-4.8),
and liver diseases (2.6; 95% CI, 1.0-5.3). UC was associated with
increased mortality from digestive diseases other than IBD (3.9; 95% CI,
2.4-6.0). The relationship with CD mortality was 0.7 for aminosalicylates
(95% CI, 0.5-1.1), 1.3 (95% CI, 0.9-1.9) for immunomodulators, and 1.0
(95% CI, 0.7-1.4) for corticosteroids. Among patients with UC, these odds
ratios were 0.8 (95% CI, 0.5-1.1) for aminosalicylates, 0.5 (95% CI,
0.3-0.9) for immunomodulators, and 0.8 (95% CI, 0.6-1.1) for
corticosteroids. CONCLUSIONS: Mortality is increased in CD. Infections,
respiratory diseases, and digestive diseases are important specific causes
of death. IBD medication use has varying associations with mortality.