More evidence Early mortality persists in IBD

Life expectancy in patients with inflammatory bowel disease (IBD) is increasing, but there remains a mortality gap between patients with and without IBD, a Canadian census reported. And due to the negative effects of pain on daily functioning that contribute to a reduced life expectancy adjusted for health, better pain relief strategies are needed.

A cohort study led by Eric Benchimol, MD, and PhD of the University of Toronto and a hospital for sick children in Toronto found the following pattern in nearly 230,000 IBD patients in 1996, 2000, 2008, and 2011: Found.

• Life expectancy for women increased from 75.5 years to 78.4 years (95% CI 1.3-4.5) for 2.9 years and for men from 72.2 to 75.5 (95% CI 2.1-4.4) for 3.2 years. ..
• Life expectancy adjusted for health decreased by 3.9 years (95% CI 1.2-6.6) in men, but was relatively stable in women, with no statistically significant changes. The difference is 2.0 years (95% CI – 1.6 to 5.7).
• Life expectancy differences between IBD patients and non-IBD controls ranged from 6.6 to 8.1 years for women and 5.0 to 6.1 years for men, depending on the year.
• Differences in health-adjusted life expectancy between these two groups ranged from 9.5 to 13.5 years for women and 2.6 to 6.7 years for men.
• Life expectancy was significantly increased in women with Crohn’s disease, but not in women with ulcerative colitis, depending on the type of IBD.

The survey results are Published on Monday CMAJ, Canadian Medical Association Journal.

“Life expectancy in IBD patients has improved over the last 15 to 20 years, but I’m worried that despite all advances in the treatment of IBD, life expectancy may still be lower than in people without IBD. “Benchimol said. Today’s MedPage. “In addition, life expectancy, a measure of quality of life, is significantly lower in people with IBD. Our treatment is stable in women or lower in men. We haven’t achieved all the goals we wanted yet. “

Between those with and without IBD when assessed for both general well-being and pain effects, despite being introduced during the study of two biologics, infliximab (Remicade, Remicade) He said the life-adjusted life gaps were particularly large in 2001) and adalimumab (Humira, 2004).

The retrospective cohort study utilized information from health care, demographics, and health survey data available from the Ontario database.

To calculate life expectancy, researchers have life expectancy for people diagnosed with IBD based on 5-year mortality rates by age and gender in 1996, 2000, 2008, and 2011. Matched with people who are not using the table. (National Population Health Survey and Canadian Community Health Survey) Estimate life expectancy after health adjustments for 1996, 2000, and 2008.

Over the four indicators years, a total of 227,254 IBD patients matched a total of 970,164 non-IBD controls. The average age of patients with prevalence of inflammatory bowel disease increased from 42.4 to 48.3 years, and the proportion of female cases remained stable in the range of 52% to 53%.

In this study, which demonstrates the adverse effects of pain, the life expectancy of women’s health adjustments was 65.7 years (95% CI 61.9-69.6) in 1996 and 62.2 years in 2000 (using pain-induced benefits). It turned out to be 95% CI 59.1-65.2). ), And 66.1 (95% CI 63.6-68.7) in 2008 are all significantly lower than non-IBD controls. However, the health-adjusted life expectancy calculated for pain attribute utility was relatively stable in men with IBD.

The authors state that early studies found that Crohn’s disease patients had a particularly high mortality rate compared to the general population. Childhood onset disease, While studying at Ulcerative colitis It wasn’t definitive.

Michael D. Kappelmann, MD, MD, of the University of North Carolina at Chapel Hill, who was not involved in the study, agreed with the author’s conclusions and said the findings were similar to what he saw in the United States. It was.

Benchimol et al. Cited some limitations on the analysis.

• Results may be confused by phenotype or severity of the disease, information not available in health care data. Some people may not have been able to respond to the survey due to activity or severe illness, so this study may underestimate the effect of IBD on health-adjusted life expectancy. ..
• Population-based data on substance use in people under the age of 65 are not available, and only a small percentage of respondents to the Statistics Canada survey have data on potential environments or other confounding factors such as smoking and ethnicity. I got it.
• Life expectancy for IBD patients may vary depending on the age at the time of IBD diagnosis. This is a difference that studies may have missed by not comparing life expectancy of individuals diagnosed at different ages. Mortality can also increase with the duration of the illness. This goes against the life table assumption that age and gender mortality rates are constant throughout a person’s life.
• Because the analysis was based on general cases rather than incident cases, there was a lack of data on the age of diagnosis and duration of illness, and “The Immortal Hour Bias” If a patient with IBD dies before meeting the complete case definition required by the validated algorithm.