Hospital Mortality Trends of Inflammatory Bowel Disease

Abstract

Introduction: Recent studies have indicated the increasing rates of hospitalization among the Inflammatory bowel disease(IBD) patients. With rapidly improving treatment regimens for Inflammatory Bowel Disease(IBD), patients are expected to live longer. We sought to determine whether the mortality has improved over the last ten years. We also aim to determine the factors associated with mortality. Methods: National Inpatient Sample data from 2005 to 2014 was used to assess the trends. Logistic regression analysis was used to assess the various factors association with mortality. Results: 1.IBD as one of the Diagnosis: 8860 (1.6%) of 552887 IBD hospitalizations ended in death. Age-adjusted mortality increased from 608 deaths per 100,000 admissions in 2005 to 816 in 2014, peaked to 915 in 2008. Similar trends were seen in both Ulcerative colitis(UC) and Crohn's disease(CD). Mortality was high for UC than the CD (1071 vs 619 per 100,000 admissions, OR 1.71,95% CI 1.5 to 1.9, P < 0.001). On Logistic regression, Mortality is associated with Advanced age, longer Length of stay, septicemia, higher Deyo modified Charlson Comorbidity Index score, Clostridium Difficile infection, UC. Race and Sex have no effect on mortality, Obesity appears to be protective. A similar association was observed in both the UC and CD subgroups, except Female sex appears to be protective in CD. Clostridium difficile infection is associated with higher mortality in UC than Crohn's. 2.IBD as primary Diagnosis: 862 (0.5%) of 181224 admissions ended in death. The age-adjusted mortality decreased from 553 per 100,000 admissions in 2005 to 232 in 2014. Similar trends were seen in the both UC and Crohn's groups. Mortality in UC subgroup is higher than the Crohn's, OR 1.98, P < 0.001 On logistic regression, Septicemia, advanced age, longer Length of stay, higher Deyo Modified Charlson Index, Clostridium difficile infection, UC is associated with higher mortality. Obesity and Calendar year appears to be protective. The most common primary Diagnosis for IBD patient's admission is IBD followed by Intestinal obstruction without Hernia, Septicemia, for the patient with mortality is Septicemia, IBD, Respiratory Failure, Intestinal Infection, Pneumonia. Conclusion: The hospital mortality rates have improved in patients with IBD as the primary diagnosis but not in the patients with any primary diagnosis in this large national hospital database.Figure: Mortality trends Total IBD admissions vs admission with IBD as primary Diagnosis.Figure: Ulcerative Colitis and Crohns mortality trends.Figure