Background and Aims We sought to identify clinical and demographic features influencing hospitalization and colectomy in a population-based inception cohort of ulcerative colitis. Methods Between 1970 and 2004, a total of 369 patients (58.5% males) from Olmsted County, Minnesota were followed from diagnosis for 5,401 person-years. The cumulative probability of hospitalization and colectomy were estimated using the Kaplan-Meier method. Cox proportional hazards regression was used to identify factors associated with hospitalization and colectomy. Results The cumulative probability of first hospitalization was 29.4% at 5 years (95% confidence interval [CI], 24.5%–34.1%), 38.7% at 10 years (33.1% –43.8%), 49.2% at 20 years (42.7% –55.2%) and 52.3% at 30 years (45.1% –59.7%). The incidence rate of hospitalizations decreased over the last four decades, although cumulative probability of first hospitalization increased with successive decades of diagnosis. Early need for corticosteroids (hazard ratio [HR], 1.8; 95% CI, 1.1–2.7) and early need for hospitalization (HR, 1.5; 1.02–2.4) were independent predictors of hospitalization after 90 days of illness. The cumulative probability of colectomy from time of diagnosis was 13.1% at 5 years (95% CI, 9.4% –16.6%), 18.9% at 10 years (14.4% –23.2%), and 25.4% at 20 years (19.8% –30.8%). Male gender (HR, 2.1; 95% CI, 1.3–3.5), diagnosis in the 1990s (HR, 2.0; 1.01–4.0) and diagnosis in 2000–2004 (HR, 3.7; 1.7–8.2) were significantly associated with colectomy risk. Conclusion Colectomy rates were comparable to reports from northern Europe. The numbers of hospitalizations show a decreasing trend. Male gender and being diagnosed in the 2000–04 period predicted colectomy while extensive colitis predicted future hospitalizations.

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