Abstract
BACKGROUND: The benefits of recent improvements in IBD care on life expectancy (LE) and health-adjusted life expectancy (HALE) are unknown. AIMS: To compare LE and HALE in people with and without IBD and evaluate the impact of narcotics and IBD medications on LE. METHODS: Cases of IBD and controls (matched on age, sex, rurality, and income) were identified from health administrative data in Ontario using validated algorithms. Five-year mortality rates and period life tables were used to calculate LE in 1996, 2000, 2008, and 2011. Health Utility Index (HUI) (from the National Population Health Study and Canadian Community Health Survey) is a utility-based measure of health-related quality of life which was combined with period life tables to estimate HALE in 1996, 2000, and 2008. Prescription records from Ontario Drug Benefits (for patients ≥65 y old) and Narcotic Monitoring System (all ages) were used to determine the effect of medications on LE. RESULTS: LE significantly increased from 75.5y to 78.4y (Δ2.9y, 95%CI 1.3 to 4.5) in females and from 72.2y to 75.5y (Δ3.2y, 95%CI 2.1 to 4.4) in males with IBD (Figure). HALE was stable over time in females (Δ2.0y, 95%CI -1.6 to 5.7; 1996: 62.3y; 2008: 64.3y) but decreased in males (Δ-3.9y, 95%CI -6.6 to -1.2; 1996: 67.0y; 2008: 63.1y) with IBD. Both LE and HALE were significantly lower in those with IBD than controls (LE: females Δ6.6–8.1y, males Δ5.0–6.1y; HALE: females Δ9.5–13.5y, males Δ2.6–6.7y). Opioid use reduced life expectancy (chronic vs. non-users: females Δ-22.1, 95%CI -25.0 to -19.2; males Δ-36.0y, 95%CI -62.4 to -9.7; non-chronic vs. non-users: females -4.7, 95%CI -6.4 to -3.0; males Δ-2.7y, 95%CI -3.8 to -1.6). Systemic steroids, opioids, and their combination shortened LE and mesalamine lengthened LE in IBD patients ≥65y (see Table). CONCLUSIONS: Although LE increased over time in patients with IBD, the gap in LE between those with and without IBD remained significant. Increases in LE were not accompanied by increased HALE. Use of steroids and opioids had very negative consequences on LE. Decisions with regard to treatment strategies for patients with IBD should incorporate data on the differences in LE for different treatment groups. FUNDING AGENCIES: CAG, CCC, CIHR