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Temporal trend in inpatient mortality in inflammatory bowel disease-associated colorectal cancer vs non-inflammatory colorectal cancer: a nationwide retrospective study

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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.

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Authors and Affiliations

  1. Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA

    Estefania Flores, Ikechukwu Achebe, Jennifer Asotibe, Emmanuel Palomera-Tejeda, Ishaan Vohra & Victor Udechukwu

  2. Gastroenterology and Hepatology, Yale School of Medicine, New Haven, CT, USA

    Chimezie Mbachi

  3. Division of Gastroenterology and Hepatology, Cook County Health and Hospitals System, County, Chicago, IL, USA

    Vikram Kotwal

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  1. Estefania Flores
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  2. Chimezie Mbachi
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Correspondence to Estefania Flores.

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Brief summary

The article’s main point is to evaluate the prevalence and temporal trend of mortality in inflammatory bowel disease-associated colorectal cancer (IBD-CRC) versus non-IBD-CRC, given the scarcity in studies investigating this topic in general and specifically the USA.

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Flores, E., Mbachi, C., Achebe, I. et al. Temporal trend in inpatient mortality in inflammatory bowel disease-associated colorectal cancer vs non-inflammatory colorectal cancer: a nationwide retrospective study. Int J Colorectal Dis 36, 701–708 (2021). https://doi.org/10.1007/s00384-020-03775-9

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