Temporal trend in inpatient mortality in inflammatory bowel disease-associated colorectal cancer vs non-inflammatory col
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ORIGINAL ARTICLE
Temporal trend in inpatient mortality in inflammatory bowel disease-associated colorectal cancer vs non-inflammatory colorectal cancer: a nationwide retrospective study Estefania Flores 1 & Chimezie Mbachi 2 & Ikechukwu Achebe 1 & Jennifer Asotibe 1 & Emmanuel Palomera-Tejeda 1 & Ishaan Vohra 1 & Victor Udechukwu 1 & Vikram Kotwal 3 Accepted: 8 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Early detection and advancement in therapy have successfully achieved a steady decrease in colorectal cancer (CRC) mortality over the last two decades. On the other hand, studies investigating mortality trends in inflammatory bowel disease-associated CRC (IBD-CRC) are scarce and inconclusive. We conducted a retrospective analysis aiming to identify differences between inpatient mortality trends in IBD-CRC vs non-IBD-CRC and possible contributing factors. Methods The National Inpatient Sample (NIS) database from 2006-2014 was queried to identify all patients admitted with a diagnosis of CRC. The main outcome was the prevalence and trend of mortality among IBD-CRC and non-IBD-CRC. The secondary outcome was the evaluation of predictors of inpatient mortality. Results A total of 1,190,759 weighted cases with the admission diagnosis of CRC were included in the study. Of which 10,997 (0.9%) had a co-diagnosis of IBD. The population with non-IBD-CRC had a statistically significant downward temporal trend in mortality (p < 0.001), while patients with IBD-CRC did not have any statistically significant temporal trend in inpatient mortality (p = 0.067). After subgroup analysis, patients with Crohn’s disease-CRC had an upward temporal trend in mortality (p = 0.183) compared to patients with ulcerative colitis-CRC with a downward trend in mortality (p = 0.001). Sepsis resulted to be a stronger predictor of mortality for CD-CRC, while VTE for UC-CRC. Conclusion Multiples strategies established to prevent morbidity and mortality in CRC have been fruitful in non-IBD-CRC population, but have not been enough for IBD-CRC population to cause the same effect. Further strategies are needed to achieve a reduction in IBD-CRC mortality trend. Keywords Inflammatory bowel disease-associated colorectal cancer . Crohn’s disease-associated colorectal cancer . Ulcerative colitis-associated colorectal cancer . Mortality in inflammatory bowel disease
Introduction Colorectal cancer (CRC) is the second most common cause of cancer-related deaths in the USA [1]. According to the
* Estefania Flores [email protected] 1
Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA
2
Gastroenterology and Hepatology, Yale School of Medicine, New Haven, CT, USA
3
Division of Gastroenterology and Hepatology, Cook County Health and Hospitals System, County, Chicago, IL, USA
National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER), CRC accounted for 8.3% of new cancer cases and 8.4% of cancer deaths in the USA in 2019 [1]. Nevertheless,
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