ORIGINAL ARTICLE Mortality Trends in Crohn’s Disease and Ulcerative Colitis: A Population-based Study in Québec, Canada Alain Bitton, MD,* ,† Maria Vutcovici, MD, MSc,* Maida Sewitch, PhD,* Samy Suissa, PhD, † ,‡ and Paul Brassard, MD, MSc †,‡ Background: Mortality rates greater than in the general population have been reported in the population with Crohn’s disease (CD), but reports for ulcerative colitis (UC) are conflicting. Trends with time were rarely described. We aimed to assess whether CD and UC mortality in Québec differs from that in the general population and to describe the trends over a 10-year observation period. Methods: This is a population-based cohort study using the Québec administrative health databases and death certificates registry. All-cause and cause-specific standardized mortality ratios (SMRs) were computed for 1999 to 2008. A time trend analysis was used to assess changes in the SMR with the calendar year. Results: All-cause mortality was significantly increased in CD and UC compared to the general population: SMR: CD 1.45 (95% confidence interval: 1.34–1.58), UC 1.21 (95% confidence interval: 1.12–1.32). In CD, mortality from digestive conditions, all neoplasms, digestive neoplasms, and colorectal, lymphatic, and lung cancer was significantly higher than in the general population. In UC, mortality from digestive, respiratory, and infectious conditions was also significantly increased. In both CD and UC, there was a decrease with time in all-cause SMRs and in digestive conditions, digestive neoplasms, colorectal cancer, and infectious diseases. SMRs for lung cancer and respiratory conditions increased over time in CD. Conclusions: All-cause mortality was significantly higher in CD and UC populations than in the general population. However, a decreasing trend with time was observed in all-cause and some cause-specific SMRs. In CD, SMRs for lung cancer and respiratory conditions increased during the observation period. (Inflamm Bowel Dis 2016;22:416–423) Key Words: inflammatory bowel disease, mortality, SMR, trend I nflammatory bowel disease (IBD) is associated with chronic evolution often complicated by relapses and increased morbid- ity. The mortality rates, however, are low and controversy exists over whether they differ substantially from those in the general population. Furthermore, there is a lack of data regarding changes in mortality over time. In the context of improvements in the approach to management related to enhanced multidisciplinary care, the introduction of immunosuppressive treatment early dur- ing the course of IBD, and the increase in use of anti-TNF med- ication in the last decade, the analysis of mortality trends may reveal the impact of such changes in the population. The few IBD mortality studies from North America focused mainly on the US population, 1–4 and trends with time have not been described. We aimed to assess whether mortality among Québec residents with Crohn’s disease (CD) and ulcerative colitis (UC) differs from that in the general population and to describe the temporal relationship between mortality in CD and UC residents and that in the general population during 1999 to 2008. MATERIALS AND METHODS Source of Data Canada has a universal health care system that provides access to medical services to residents in all provinces and territories. The Québec provincial health care databases are admin- istered by the Regie de l’Assurance Maladie du Québec (RAMQ). The databases contain routinely collected records of physician bill- ings, hospital discharge summaries, prescriptions dispensed under the provincial public drug plan, and demographic information. The public drug plan covers approximately 40% of the Québec popula- tion, including all residents 65 years and older, recipients of social assistance, and residents not eligible for private drug plans. The Québec Statistics Institute (ISQ) administers the death registry re- cords, which contain the diagnosis for the initial cause of death and up to 25 secondary causes of death. Study Population The source population consisted of all subjects identified in the RAMQ administrative health databases during 1996 to 2009 with either a physician billing or a hospitalization for CD or UC. Received for publication August 7, 2015; Accepted August 18, 2015. From the *Division of Gastroenterology, McGill University Health Centre, Mon- tréal, QC, Canada; † Department of Medicine, McGill University, Montréal, QC, Canada; and ‡ Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada. Support by internal funding from the McGill University Health Centre. The authors have no conflict of interest to disclose. Reprints: Alain Bitton, MD, Division of Gastroenterology, McGill University Health Centre, Glen Site, 1001 Décarie Boulevard, D5 North, Room D05.7150, Montréal, QC H4A 3J1, Canada (e-mail: alain.bitton@muhc.mcgill.ca). Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000608 Published online 11 January 2016. 416 | www.ibdjournal.org Inflamm Bowel Dis  Volume 22, Number 2, February 2016 Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.