Trends and risk factors of mortality analysis in patients with inflammatory bowel disease: a Taiwanese nationwide population-based study

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Abstract

Background

Inflammatory bowel disease (IBD) was emerging as a worldwide epidemic disease, and the advanced therapy changed the clinical course and possibly the outcomes. Our previous study reported a higher mortality rate from (IBD) in Taiwan than in Western countries. We proposed to analyze the trend and risk factors of mortality in order to improve the care quality of IBD patients.

Methods

This retrospective study was conducted to analyze data for January 2001 to December 2015 from a registered database, compiled by the Taiwan’s National Health Insurance.

Results

Between 2001 and 2015, a total of 3806 IBD patients [Crohn’s disease (CD): 919; ulcerative colitis (UC): 2887] were registered as having catastrophic illness, and 8.2% of these patients died during follow-up. The standardized mortality ratios (SMRs) of CD and UC were 3.72 (95% CI 3.02–4.55) and 1.44 (95% CI 1.26–1.65), respectively, from 2001 to 2015, respectively. A comparison of the periods of 2011–2015 and 2001–2005 revealed a decrease in the mortality rates from both UC and CD. Multivariate Cox proportional hazards analysis identified elderly individuals; sepsis and pneumonia were the risk factors for IBD mortality. The specific risk factors of mortality were liver cancer for UC and surgeries for CD.

Conclusion

For further decreasing IBD-related mortality in Taiwan, we need to pay special attention toward elderly individuals, infection control, cancer screening and improvement in perioperative care.

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Most cited references 28

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Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study.

Siew C. Ng, Whitney Tang, Jessica Y. L. Ching … (2013)

Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001). We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

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Changing epidemiological trends of inflammatory bowel disease in Asia

Wee Ng, Sunny Wong, Siew C. Ng (2016)

Inflammatory bowel disease (IBD) has become more common in Asia over the past few decades. The rate of increase in prevalence of the disease varies greatly in Asia, with several countries in East Asia experiencing a more than doubled increase in IBD prevalence over the past decade. Historically, ulcerative colitis (UC) is more common than Crohn's disease (CD) in Asia. However, a reverse trend is beginning to appear in more developed countries in Asia such as Japan, Korea, and Hong Kong. While Asian IBD patients share many similarities with their Western counterparts, there are important differences with significant clinical implications. In Asia, there are more men with CD, more ileo-colonic involvement in CD, less familial aggregation, fewer extra-intestinal manifestations and worse clinical outcomes for older-onset patients with UC. These differences are likely related to the different genetic makeup and environmental exposures in different regions. Evaluation of the differences and rates in epidemiologic trends may help researchers and clinicians estimate disease burden and understand the reasons behind these differences, which may hold the key to unravel the etiology of IBD.

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Incidence and survival of adult cancer patients in Taiwan, 2002-2012.

Chun-Ju Chiang, Wei-Cheng Lo, Ya-Wen Yang … (2016)

Little is known about the annual changes in cancer incidence and survival that occurred after the establishment of the long-form cancer registry database in Taiwan. Therefore, this study aimed to investigate the updated incidence and stage-specific relative survival rates (RSRs) among adult cancer patients in Taiwan.

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Author and article information

Contributors

Shu-Chen Wei:

ORCID: http://orcid.org/0000-0002-5017-5840

shuchenwei@ntu.edu.tw

Journal

Journal ID (nlm-ta): J Transl Med

Journal ID (iso-abbrev): J Transl Med

Title: Journal of Translational Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1479-5876

Publication date (Electronic): 12 December 2019

Publication date PMC-release: 12 December 2019

Publication date Collection: 2019

Volume: 17

Electronic Location Identifier: 414

Affiliations

[1 ]GRID grid.413593.9, ISNI 0000 0004 0573 007X, Division of Gastroenterology, Department of Internal Medicine, , MacKay Memorial Hospital, ; Taipei City, Taiwan

[2 ]GRID grid.412146.4, ISNI 0000 0004 0573 0416, MacKay Junior College of Medicine, , Nursing and Management, ; Taipei, Taiwan

[3 ]GRID grid.452449.a, ISNI 0000 0004 1762 5613, MacKay Medical College, ; Taipei, Taiwan

[4 ]Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan

[5 ]GRID grid.19188.39, ISNI 0000 0004 0546 0241, School of Medicine, , National Taiwan University, ; Taipei City, Taiwan

[6 ]GRID grid.19188.39, ISNI 0000 0004 0546 0241, Health Data Research Center, National Taiwan University, ; Taipei City, Taiwan

[7 ]Department of Internal Medicine, West Garden Hospital, Taipei City, Taiwan

[8 ]GRID grid.412094.a, ISNI 0000 0004 0572 7815, Inflammatory Bowel Disease Clinical and Study Integrated Center, , National Taiwan University Hospital, ; Taipei City, Taiwan

Author information

Shu-Chen Wei http://orcid.org/0000-0002-5017-5840

Article

Publisher ID: 2164

DOI: 10.1186/s12967-019-02164-3

PMC ID: 6909461

PubMed ID: 31831015

SO-VID: 4cae29b5-4878-49ba-96db-b345d2997e42

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 10 September 2019

Date accepted : 2 December 2019

Funding

Funded by: National Taiwan University Hospital Research Program

Award ID: Ms160

Award Recipient : Jau-Min Wong

Funded by: National Taiwan University Hospital Research Program

Award ID: 107-A139

Award Recipient : Shu-Chen Wei

Funded by: Liver Disease Prevention and Treatment Research Foundation, Taiwan

Award ID: not applicable

Award ID: not applocable

Award Recipient : Meng-Tzu Weng Shu-Chen Wei

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ScienceOpen disciplines: Medicine

Keywords: crohn’s disease,inflammatory bowel disease,mortality,risk factors,ulcerative colitis

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ScienceOpen disciplines: Medicine

Keywords: crohn’s disease, inflammatory bowel disease, mortality, risk factors, ulcerative colitis

Trends and risk factors of mortality analysis in patients with inflammatory bowel disease: a Taiwanese nationwide population-based study

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Most cited references 28

Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study.

Changing epidemiological trends of inflammatory bowel disease in Asia

Incidence and survival of adult cancer patients in Taiwan, 2002-2012.

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