Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
National Institute for Health Research [NIHR] Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
J Crohns Colitis. 2017 May 1;11(5):578-585. doi: 10.1093/ecco-jcc/jjw192.
Numerous studies have established that mortality risk in inflammatory bowel disease [IBD] patients is higher than in the general population, but the causes of death have seldom been examined. We aimed to describe causes of death in IBD.
A matched cohort study using UK general practice data from Clinical Practice Research Datalink linked to death registration records. We described the distribution of causes of death among IBD patients by age at death and time since IBD diagnosis. We estimated age-specific mortality rates and hazard ratios of death in multivariable Cox proportional hazards models.
20293 IBD patients were matched to 83261 non IBD patients. The mortality rate was 40% higher in IBD patients [2005 deaths] than in non IBD patients [6024 deaths] (adjusted overall hazard ratio: = 1.4, 95% confidence interval [CI]: = 1.4-1.5], with greater risk of death in Crohn's disease [hazard ratio: = 1.6, 1.5-1.7] than in ulcerative colitis [1.3, 1.3-1.4]. Causes attributable to IBD constituted 3.7% of all deaths in ulcerative colitis and 8.3% in Crohn's disease. Among IBD patients, death was less likely to be due to circulatory, respiratory or neoplastic diseases than among non IBD patients. In both IBD and non IBD patients all these causes became more clinically important with advancing age, with the commonest neoplastic cause of death being lung cancer rather than gastrointestinal cancers.
IBD patients have an additional risk of death. Most IBD patients die of circulatory or respiratory causes, and the contribution to mortality from long-term complications of IBD is clinically less important.
大量研究表明，炎症性肠病（IBD）患者的死亡风险高于一般人群，但死亡原因很少被研究。本研究旨在描述 IBD 患者的死亡原因。
这是一项基于英国普通实践数据的匹配队列研究，数据来自临床实践研究数据链接与死亡登记记录的链接。我们按死亡时的年龄和 IBD 诊断后的时间描述了 IBD 患者的死亡原因分布。我们在多变量 Cox 比例风险模型中估计了特定年龄的死亡率和死亡风险比。
20293 例 IBD 患者与 83261 例非 IBD 患者相匹配。IBD 患者的死亡率比非 IBD 患者高 40%（2005 例死亡）[6024 例死亡]（调整后的总体风险比：=1.4，95%置信区间[CI]：=1.4-1.5]，克罗恩病的死亡风险更高[风险比：=1.6，1.5-1.7]，溃疡性结肠炎为 1.3，1.3-1.4]。归因于 IBD 的原因占溃疡性结肠炎所有死亡的 3.7%，克罗恩病的 8.3%。在 IBD 患者中，与非 IBD 患者相比，循环、呼吸或肿瘤疾病导致的死亡不太可能。在 IBD 和非 IBD 患者中，所有这些原因随着年龄的增长变得更加重要，最常见的肿瘤死亡原因是肺癌而不是胃肠道癌症。
IBD 患者的死亡风险更高。大多数 IBD 患者死于循环或呼吸原因，IBD 长期并发症对死亡率的影响在临床上并不重要。
