13-year mortality trends among hospitalized patients with inflammatory bowel disease

BMC Gastroenterology

Hal F Yee¹  Justin L Sewell¹ 

[1] Center for Innovation in Access and Quality, Department of Medicine, Division of Gastroenterology and Hepatology, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA

关键词: Outcomes;    In-hospital mortality;    Mortality;    Epidemiology;    Hospitalization;    Ulcerative colitis;    Crohn’s disease;    Inflammatory bowel disease;   

Others  :  1113018
DOI  :  10.1186/1471-230X-12-79

 received in 2011-12-19, accepted in 2012-06-18,  发布年份 2012

【 摘 要 】

Background

Studies document increasing rates of hospitalization among patients with inflammatory bowel disease, but temporal trends for in-hospital mortality among patients with inflammatory bowel disease are not characterized. We sought to determine whether in-hospital mortality changed over a 13-year period among nationwide hospitalizations associated with inflammatory bowel disease. We additionally sought to identify factors correlated with mortality.

Methods

We used the National Hospital Discharge Survey, a large nationally representative database, for the years 1994 through 2006. Age- and mortality-adjusted rates of in-hospital mortality and standardized mortality ratios were calculated for four time periods. Logistic regression analysis was used to assess associations between advancing time and mortality in adjusted analyses.

Results

150 (0.9%) of 17,393 hospitalizations for patients with inflammatory bowel disease ended in death. Age-adjusted in-hospital mortality decreased from 3.6 deaths per 1,000 hospital days in 1994–96 to 2.4 per 1,000 in 2003–06; standardized mortality ratio decreased from 0.33 to 0.27. Similar trends were seen for patients with ulcerative colitis, but mortality did not change over time among patients with Crohn’s disease. Multivariable logistic regression analysis confirmed the significance of these changes in mortality, with 17% decreased odds of in-hospital death per three-year period (P = 0.012). Subject age (OR 1.06 per year, P < 0.001), Charlson comorbidity index (OR 1.29 per 1-point increase, P < 0.001), and diagnosis of ulcerative colitis (versus Crohn’s disease, OR 1.41, P = .042) were also associated with in-hospital mortality.

Conclusions

The odds of in-hospital mortality among hospitalized patients with inflammatory bowel disease decreased by 17% per 3-year period from 1994 to 2006 in analysis adjusted for age and comorbidity status, in this large, nationally representative database. Multiple factors likely contribute to these trends.

【 授权许可】

   
2012 2012 Sewell and Yee et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Kappelman MD, Rifas-Shiman SL, Kleinman K, Ollendorf D, Bousvaros A, Grand RJ, Finkelstein JA: The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol 2007, 5(12):1424-1429.
• [2]Kappelman MD, Rifas-Shiman SL, Porter CQ, Ollendorf DA, Sandler RS, Galanko JA, Finkelstein JA: Direct health care costs of Crohn's disease and ulcerative colitis in US children and adults. Gastroenterology 2008, 135(6):1907-1913.
• [3]Nguyen GC, Laveist TA, Gearhart S, Bayless TM, Brant SR: Racial and geographic variations in colectomy rates among hospitalized ulcerative colitis patients. Clin Gastroenterol Hepatol 2006, 4(12):1507-1513.
• [4]Nguyen GC, Bayless TM, Powe NR, Laveist TA, Brant SR: Race and health insurance are predictors of hospitalized Crohn's disease patients undergoing bowel resection. Inflamm Bowel Dis 2007, 13(11):1408-1416.
• [5]Dennison C, Pokras R: Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Stat 1 2000, 39(39):1-42.
• [6]Somsouk M, Yee HF, Biggins SW: Understanding liver health using the National Center for Health Statistics. Dig Dis Sci 2009, 54(11):2325-2329.
• [7]Ananthakrishnan AN, McGinley EL, Binion DG: Does it matter where you are hospitalized for inflammatory bowel disease? A nationwide analysis of hospital volume. Am J Gastroenterol 2008, 103(11):2789-2798.
• [8]Nguyen GC, Laveist TA, Brant SR: The utilization of parenteral nutrition during the in-patient management of inflammatory bowel disease in the United States: a national survey. Aliment Pharmacol Ther 2007, 26(11–12):1499-1507.
• [9]Nguyen GC, Steinhart AH: Nationwide patterns of hospitalizations to centers with high volume of admissions for inflammatory bowel disease and their impact on mortality. Inflamm Bowel Dis 2008, 14(12):1688-1694.
• [10]Nguyen GC, Sam J, Murthy SK, Kaplan GG, Tinmouth JM, LaVeist TA: Hospitalizations for inflammatory bowel disease: profile of the uninsured in the United States. Inflamm Bowel Dis 2009, 15(5):726-733.
• [11]Nguyen GC, Patel H, Chong RY: Increased prevalence of and associated mortality with methicillin-resistant Staphylococcus aureus among hospitalized IBD patients. Am J Gastroenterol 2010, 105(2):371-377.
• [12]Card T, Hubbard R, Logan RF: Mortality in inflammatory bowel disease: a population-based cohort study. Gastroenterology 2003, 125(6):1583-1590.
• [13]Loftus EV, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR: Ulcerative colitis in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gut 2000, 46(3):336-343.
• [14]Loftus EV, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR: Crohn's disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology 1998, 114(6):1161-1168.
• [15]Loftus CG, Loftus EV, Harmsen WS, Zinsmeister AR, Tremaine WJ, Melton LJ, Sandborn WJ: Update on the incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota, 1940–2000. Inflamm Bowel Dis 2007, 13(3):254-261.