Abstract
The incidence and prevalence of ulcerative colitis (UC) varies geographically. The risk of colorectal cancer (CRC) and possibly some other malignancies is increased among patients with UC. It is still debated if patients with UC are at a greater risk of dying compared with the general population. Our aim was to describe the epidemiology and mortality of the Hungarian UC population from 2010 to 2016 and to analyze the associated malignancies with a special focus on CRC. This is an observational, descriptive, epidemiological study based on the National Health Insurance Fund social security databases from 2010 to 2016. All adult patients who had at least two events in outpatient care or at least two medication prescriptions, or at least one inpatient event with UC diagnosis were analyzed. Malignancies and CRC were defined using ICD-10 codes. We also evaluated the survival of patients suffering from UC compared with the general population using a 3 to 1 matched random sample (age, gender, geography) from the full population of Hungary. We found the annual prevalence of UC 0.24-0.34%. The incidence in 2015 was 21.7/100 000 inhabitants. Annual mortality rate was 0.019-0.023%. In this subpopulation, CRC was the most common cancer, followed by non-melanotic skin and prostate cancer. 8.5% of the UC incident subpopulation was diagnosed with CRC. 470 (33%) of the CRC patients died during the course of the study (25% of all deaths were due to CRC), the median survival was 9.6 years. UC patients had significantly worse survival than their matched controls (HR = 1.65, 95% CI: 1.56-1.75). This is the first population-based study from Eastern Europe to estimate the different malignancies and mortality data amongst Hungarian ulcerative colitis patients. Our results revealed a significantly worse survival of patients suffering from UC compared to the general population.
Highlights
Ulcerative colitis (UC) is a chronic inflammation of the colon with an unknown etiology
In 2010 there was only a 3-year baseline period for patients, while in 2015 this baseline period was longer (8 years). This causes that patients incident in real life before 2007 with longer gaps in their medical history of ulcerative colitis (UC) have a chance to be identified as an incident patient at the beginning of the study but this probability is much smaller in the later years
The mortality trend of the Hungarian UC population is in concordance with the trend observable in the general population of Hungary, our results revealed a significantly worse survival of UC patients suffering from colorectal cancer (CRC) than that of the general population
Summary
Ulcerative colitis (UC) is a chronic inflammation of the colon with an unknown etiology. The population-based study of the ECCO EpiCom-group (European Crohn’s and Colitis Organization– Epidemiological Committee) revealed an east-west gradient in the incidence of IBD. They found higher incidence rates in Western European countries, and lower ones in Eastern European countries (except for Hungary), where the incidence rates were similar to the Nordic countries. Almost all countries had higher incidence rates in 2010 in contrast to the older studies These findings were validated by the 2011 ECCO-EpiCom inception cohort study with similar results. The incidence and prevalence of ulcerative colitis (UC) varies geographically. Our aim was to describe the epidemiology and mortality of the Hungarian UC population from 2010 to 2016 and to analyze the associated malignancies with a special focus on CRC
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