Mortality in patients with Crohn’s disease in Örebro, Sweden 1963–2010

Some studies have suggested a reduced life expectancy in patients with Crohn’s disease (CD) compared with the general population. The evidence, however, is inconsistent. Prompted by such studies, we studied survival of CD patients in Örebro county, Sweden. From the medical records, we identified all patients diagnosed with CD during 1963–2010 with follow-up to the end of 2011. We estimated: overall survival, net and crude probabilities of dying from CD, relative survival ratio (RSR), and excess mortality rate ratios (EMRR) at 10-year follow-up. The study included 492 patients (226 males, 266 females). Median age at diagnosis was 32 years (3–87). Net and crude probabilities of dying from CD increased with increasing age and were higher for women. Net survival of patients aged ≥60 at diagnosis was worse for patients diagnosed during 1963–1985 (54%) than for patients diagnosed during 1986–1999 (88%) or 2000–2010 (93%). Overall, CD patients’ survival was comparable to that in the general population [RSR = 0.98; 95% CI: (0.95–1.00)]. However, significantly lower than expected survival was suggested for female patients aged ≥60 diagnosed during the 1963–1985 [RSR = 0.47 (0.07–0.95)]. The adjusted model suggested that, compared with diagnostic period 1963–1985, disease-related excess mortality declined during 2000–2010 [EMRR = 0.36 (0.07–1.96)]; and age ≥60 at diagnosis [EMRR = 7.99 (1.64–39.00), reference: age 40–59], female sex [EMRR = 4.16 (0.62–27.85)], colonic localization [EMRR = 4.20 (0.81–21.88), reference: ileal localization], and stricturing/penetrating disease [EMRR = 2.56 (0.52–12.58), reference: inflammatory disease behaviour] were associated with poorer survival. CD-related excess mortality may vary with diagnostic period, age, sex and disease phenotype.Key summaryThere is inconsistent evidence on life expectancy of patients with Crohn’s diseaseCrohn’s disease-specific survival improved over time.Earlier diagnosis period, older age at diagnosis, female sex, colonic disease and complicated disease behaviour seems to be associated with excess Crohn’s disease-related mortality. There is inconsistent evidence on life expectancy of patients with Crohn’s disease Crohn’s disease-specific survival improved over time. Earlier diagnosis period, older age at diagnosis, female sex, colonic disease and complicated disease behaviour seems to be associated with excess Crohn’s disease-related mortality.</p

Table S1 from Beta-Blocker Drug Use and Survival among Patients with Pancreatic Adenocarcinoma

Lists β-blocking agents redeemed by the study cohort and associated ATC codes.</p

Table S2 from Beta-Blocker Drug Use and Survival among Patients with Pancreatic Adenocarcinoma

Lists other medications used by the study cohort and associated ATC codes.</p

Figure S1 from Beta-Blocker Drug Use and Survival among Patients with Pancreatic Adenocarcinoma

Study population selection process</p

Cardiovascular disease risk factors among people with and without new onset depression at baseline.

Cardiovascular disease risk factors among people with and without new onset depression at baseline.</p

Cohort diagrams.

<p>(A) History of depression cohort (B) New onset depression cohort.</p

Hazard ratios (HR) and 95% confidence intervals (95%CI) by gender for the association of history of depression with 12 cardiovascular diseases, adjusted for age, smoking, systolic blood pressure, diabetes, cholesterol, and socio-economic status (94,432 events in 958,329 men and 979,031 women).

<p><b>P-values for interaction between gender and history of depression: stable angina p = 0.618, unstable angina p = 0.174, myocardial infarction p = 0.210, unheralded coronary death p = 0.478, heart failure p = 0.101, cardiac arrest/sudden cardiac death p = 0.972, transient ischaemic attack p = 0.632, ischaemic stroke p = 0.113, subarachnoid haemorrhage p = 0.683, intracerebral haemorrhage p = 0.612, peripheral arterial disease p = 0.265, abdominal aortic aneurysm p = 0.303.</b> Abbreviation: SCD; sudden cardiac death.</p

Hazard ratios (HR) and 95% confidence interval (95%CI) for the association of history of depression with 12 cardiovascular diseases, adjusted for age, gender, smoking, systolic blood pressure, diabetes, cholesterol, and socio-economic status (94,432 events in 1,937,360 men and women).

<p>Abbreviations: CHD, coronary heart disease; SCD, sudden cardiac death. Vertical dotted line indicates the HRs for total cardiovascular diseases: HR = 1.28 (95%CI 1.26–1.30).</p

Cumulative incidence rate (IR) of 12 cardiovascular diseases per 100,000 person-years at risk (PYR) among people with new onset depression at baseline and with history of depression prior to baseline.

<p>Cumulative incidence rate (IR) of 12 cardiovascular diseases per 100,000 person-years at risk (PYR) among people with new onset depression at baseline and with history of depression prior to baseline.</p

Hazard ratios (HR) and 95% confidence interval (95%CI) for the association of new onset depression with 12 cardiovascular diseases, adjusted for age, gender, smoking, systolic blood pressure, diabetes, cholesterol, and socio-economic status (63,761 events in 1,356,578 men and women).

<p>Abbreviations: CHD; coronary heart disease, SCD; sudden cardiac death. Vertical dotted line indicates the HRs for total cardiovascular diseases: HR = 1.30 (95%CI 1.24–1.35).</p