Overall and Cause-Specific Mortality in Ulcerative Colitis: Meta-Analysis of Population-Based Inception Cohort Studies

Am J Gastroenterol. 2007 Mar;102(3):609-17. doi: 10.1111/j.1572-0241.2006.01000.x.


Objectives: It remains debated whether patients with ulcerative colitis (UC) are at greater risk of dying and whether a possible alteration in mortality can be attributed to specific causes of death. We aimed to clarify this issue by conducting a meta-analysis of population-based inception cohort studies on overall and cause-specific mortality in patients with UC.

Methods: The MEDLINE search engine and abstracts from international conferences were searched for relevant literature by use of explicit search criteria. STATA meta-analysis software was used to calculate pooled risk estimates (SMR, standardized mortality ratio, observed/expected deaths) of overall mortality and specific causes of death and to conduct metaregression analyses of the influence of specific variables on SMR.

Results: Ten papers fulfilled the inclusion criteria, reporting SMRs varying from 0.7 to 1.4. The overall pooled estimate was 1.1 (95% confidence interval [CI] 0.9-1.2, P= 0.42). However, greater risk of dying was observed during the first years of follow-up, in patients with extensive colitis, and in patients from Scandinavia. Metaregression analysis showed an increase in SMR by increasing cohort size. UC-related mortality accounted for 17% of all deaths. Mortality from gastrointestinal diseases, nonalcoholic liver diseases, pulmonary embolisms, and respiratory diseases was increased whereas mortality from pulmonary cancer was reduced.

Conclusions: The overall risk of dying in patients with UC did not differ from that of the background population, although subgroups of patients were at greater risk of dying. The cause-of-death distribution seemed to differ from that of the background population.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Cause of Death / trends
  • Cohort Studies
  • Colitis, Ulcerative / mortality*
  • Global Health
  • Humans
  • Population Surveillance*
  • Risk Factors
  • Survival Rate / trends