Table 4.
Hazard ratio of the first ever event of overall psychiatric morbidity and suicides in a cohort of patients with adult-onset inflammatory bowel disease [IBD]. Individuals with IBD compared with matched general population reference individuals
| Characteristic | Overall psychiatric morbidity | Suicide | ||||||
|---|---|---|---|---|---|---|---|---|
| No. of outcomes/person-years [incidence rate/1000 person- years] | No. of outcomes/person-years [incidence rate/1000 person- years] | Hazard ratio [95% CI] | p value | No. of outcomes/person-years [incidence rate/1000 person- years] | No. of outcomes/person-years [incidence rate/1000 person- years] | Hazard ratio [95% CI] | p value | |
| Patients | Reference individuals | Patients | Reference individuals | |||||
| Sex | ||||||||
| Male sex | 3479/454 890 [7.6] | 149 148/23 565 876 [6.3] | 1.2 [1.2-1.2] | <0.0001 | 147/477 827 [0.3] | 6891/24 651 152 [0.3] | 1.1 [1.0–1.3] | 0.1636 |
| Female sex | 3986/434 795 [9.2] | 157 763/22 782 565 [6.9] | 1.3 [1.3–1.4] | <0.0001 | 64/462 578 [0.1] | 2502/23 931 661 [0.1] | 1.3 [1.0–1.7] | 0.0202 |
| Country of birth | ||||||||
| Sweden | 6623/820 438 [8.1] | 276 377/42 803 832 [6.5] | 1.3 [1.2–1.3] | <0.0001 | 200/866 252 [0.2] | 8752/44 847 062 [0.2] | 1.2 [1.0–1.4] | 0.0090 |
| Other | 842/ 69 247 [12.2] | 30 534/35 44 609 [8.6] | 1.4 [1.3–1.5] | <0.0001 | 11/ 74 153 [0.1] | 641/3 735 751 [0.2] | 0.9 [0.5–1.6] | 0.6398 |
| Level of education | ||||||||
| Compulsory school | 1984/225 743 [8.8] | 84 823/11 702 559 [7.2] | 1.2 [1.2–1.3] | <0.0001 | 87/239 817 [0.4] | 3452/12 346 821 [0.3] | 1.3 [1.0–1.6] | 0.0319 |
| Upper secondary 2 years | 2222/265 434 [8.4] | 89 190/12 925 614 [6.9] | 1.2 [1.2–1.3] | <0.0001 | 58/282 280 [0.2] | 2807/13 641 645 [0.2] | 1.0 [0.8–1.4] | 0.7788 |
| Upper secondary 3 years | 1255/133 963 [9.4] | 48 434/6 806 445 [7.1] | 1.3 [1.2–1.4] | <0.0001 | 26/141 879 [0.2] | 1152/7 116 634 [0.2] | 1.1 [0.7–1.6] | 0.7639 |
| University < 3 years | 862/104 903 [8.2] | 33 071/5 488 411 [6.0] | 1.3 [1.2–1.4] | <0.0001 | 17/110 283 [0.2] | 753/5 718 476 [0.1] | 1.2 [0.7–2.1] | 0.4601 |
| University ≥3 years | 1029/147 884 [7.0] | 44 800/8 261 687 [5.4] | 1.3 [1.2–1.4] | <0.0001 | 15/153 908 [0.1] | 857/8 560 117 [0.1] | 1.1 [0.6–1.9] | 0.7058 |
| Age at IBD diagnosis and/or cohort entry, years | ||||||||
| 18 to < 40 | 4307/505 306 [8.5] | 177 644/25 796 082 [6.9] | 1.2 [1.2–1.3] | <0.0001 | 123/538 230 [0.2] | 5314/27 271 285 [0.2] | 1.2 [1.0–1.4] | 0.0646 |
| 40 to < 60 | 2089/267 599 [7.8] | 85 108/13 844 080 [6.1] | 1.3 [1.2–1.3] | <0.0001 | 49/280 955 [0.2] | 2720/14 418 763 [0.2] | 0.9 [0.7–1.2] | 0.6203 |
| ≥ 60 | 1069/116 780 [9.2] | 44 159/6 708 280 [6.6] | 1.4 [1.3–1.5] | <0.0001 | 39/121 220 [0.3] | 1359/6 892 765 [0.2] | 1.7 [1.3–2.4] | 0.0008 |
| Start year of follow-up, years | ||||||||
| 1973–1979 | 826/155 868 [5.3] | 38 601/8 295 298 [4.7] | 1.2 [1.1–1.2] | <0.0001 | 54/165 731 [0.3] | 2456/8 794 669 [0.3] | 1.2 [0.9–1.6] | 0.2188 |
| 1980–1989 | 1570/256 755 [6.1] | 67 208/13 414 829 [5.0] | 1.2 [1.2–1.3] | <0.0001 | 58/270 751 [0.2] | 3138/14 060 847 [0.2] | 1.0 [0.8–1.3] | 0.8895 |
| 1990–1999 | 1847/214 613 [8.6] | 74 595/11 297 818 [6.6] | 1.3 [1.2–1.4] | <0.0001 | 50/227 408 [0.2] | 2013/11 817 259 [0.2] | 1.3 [1.0–1.7] | 0.0742 |
| 2000–2013 | 3222/262 450 [12.3] | 126 507/13 340 496 [9.5] | 1.3 [1.2–1.3] | <0.0001 | 49/276 516 [0.2] | 1786/13 910 038 [0.1] | 1.4 [1.0–1.9] | 0.0224 |
| Version of ICD classification at the time of cohort entry | ||||||||
| ICD-8 [1973–1986] | 1885/338 047 [5.6] | 85 331/17 819 856 [4.8] | 1.2 [1.1–1.2] | <0.0001 | 97/357 772 [0.3] | 4790/18 787 797 [0.3] | 1.1 [0.9–1.3] | 0.4284 |
| ICD-9 [1987–1996] | 1633/210 139 [7.8] | 64 848/11 121 097 [5.8] | 1.3 [1.3–1.4] | <0.0001 | 54/222 402 [0.2] | 2127/11 625 073 [0.2] | 1.3 [1.0–1.8] | 0.0306 |
| ICD-10 [1997–2013] | 3947/341 499 [11.6] | 156 732/17 407 489 [9.0] | 1.3 [1.2–1.3] | <0.0001 | 60/360 231 [0.2] | 2476/18 169 944 [0.1] | 1.2 [0.9–1.6] | 0.1234 |
| Source of data at the time of cohort entry | ||||||||
| Inpatient register [prior to 2002] | 5116/711 748 [7.2] | 217 847/37 293 662 [5.8] | 1.2 [1.2–1.3] | <0.0001 | 180/753 521 [0.2] | 8289/39 179 989 [0.2] | 1.2 [1.0–1.3] | 0.0636 |
| Inpatient and outpatient registers [since 2002] | 2349/177 937 [13.2] | 89 064/9 054 780 [9.8] | 1.3 [1.3–1.4] | <0.0001 | 31/186 884 [0.2] | 1 104/9 402 824 [0.1] | 1.4 [1.0–2.0] | 0.0632 |
| Length of follow-up, years | ||||||||
| < 1 | 806/1 876 [430] | 23 378/ 73 151 [320] | 1.4 [1.2–1.6] | <0.0001 | 25/8690 [2.9] | 570/297 416 [1.9] | 0.6 [0.2–1.7] | 0.3073 |
| 1 to < 5 | 2 069/42 148 [49.1] | 82 569/1 998 059 [41.3] | 1.1 [1.0–1.2] | 0.0024 | 70/58 070 [1.2] | 2651/2 705 539 [1.0] | 1.1 [0.8–1.5] | 0.6274 |
| 5 to < 10 | 1700/111 537 [15.2] | 75 096/5 565 126 [13.5] | 1.0 [1.0–1.1] | 0.2839 | 46/122 757 [0.4] | 2417/6 107 664 [0.4] | 1.0 [0.7–1.5] | 0.8166 |
| ≥10 | 2890/734 123 [3.9] | 125 868/38 712 105 [3.3] | 1.2 [1.2–1.3] | <0.0001 | 70/750 888 [0.1] | 3755/39 472 195 [0.1] | 1.0 [0.8–1.3] | 0.9153 |
| Complications during follow-up | ||||||||
| Extra intestinal manifestations | 1302/122 889 [10.6] | 40 842/6 179 148 [6.6] | 1.6 [1.5–1.7] | <0.0001 | 19/132 126 [0.1] | 1163/6 487 144 [0.2] | 0.8 [0.5–1.3] | 0.3284 |
| Primary sclerosing cholangitis | 221/30 034 [7.4] | 10 146/1 643 385 [6.2] | 1.2 [1.0–1.4] | 0.0085 | 3/ 31 446 [0.1] | 388/1 724 802 [0.2] | 0.4 [0.1–1.3] | 0.1306 |
| IBD surgery | ||||||||
| Bowel surgery | 2405/331 847 [7.2] | 95 644/17 300 695 [5.5] | 1.3 [1.3–1.4] | <0.0001 | 94/352 318 [0.3] | 4296/18 191 669 [0.2] | 1.1 [0.9–1.4] | 0.2201 |
| Perianal surgery | 868/102 112 [8.5] | 31 288/5 227 059 [6.0] | 1.4 [1.3–1.5] | <0.0001 | 29/109 526 [0.3] | 1299/5 506 498 [0.2] | 1.1 [0.8–1.6] | 0.5050 |
| Psychiatric diagnoses in first degree relatives | 3828/366 707 [10.4] | 157 161/18 314 432 [8.6] | 1.2 [1.2–1.3] | <0.0001 | 109/394 684 [0.3] | 4731/19 536 671 [0.2] | 1.2 [1.0–1.4] | 0.0994 |
| Psychiatric diagnoses in parents | 1782/149 981 [11.9] | 71 633/7 360 506 [9.7] | 1.2 [1.2–1.3] | <0.0001 | 49/162 722 [0.3] | 2085/7 913 820 [0.3] | 1.3 [1.0–1.7] | 0.0912 |
| Psychiatric diagnoses in siblings | 1434/135 207 [10.6] | 60 476/6 559 666 [9.2] | 1.2 [1.1–1.2] | <0.0001 | 41/146 465 [0.3] | 1779/7 051 238 [0.3] | 1.2 [0.8–1.6] | 0.3975 |
| Psychiatric diagnoses in children | 1832/170 435 [10.7] | 75 426/8 613 156 [8.8] | 1.2 [1.2–1.3] | <0.0001 | 55/184 237 [0.3] | 2405/9 215 917 [0.3] | 1.1 [0.8–1.5] | 0.4324 |