BACKGROUND: Population-based studies have revealed varying mortality for ulcerative colitis (UC) patients, but most of them have described patients from limited geographical areas who were diagnosed before 1990. AIMS: To assess overall mortality in a European cohort of UC patients 10 years after diagnosis and to investigate national UC-related mortality across Europe. METHODS: Mortality 10 years after diagnosis was recorded in a prospective European-wide population-based cohort of UC patients diagnosed in 1991-1993 from nine centres in seven European countries. Expected mortality was calculated from the sex-, age- and country-specific mortality in the WHO Mortality Database for 1995-1998. Standardised mortality ratios (SMR) and 95% confidence intervals (CI) were calculated. RESULTS: At follow-up 661 of 775 patients were alive with a median follow-up duration of 123 months (107- 144). A total of 73 deaths (median follow-up time 61 months [1-133]) occurred, versus an expected 67. The overall mortality risk was no higher: SMR 1.09 (CI: 0.86- 1.37). Mortality by sex was: SMR 0.92 (CI 0.65-1.26) for males, and: SMR 1.39 (CI 0.97-1.93) for females. There was a slightly higher risk in older age groups. For disease-specific mortality a higher SMR was only found for pulmonary disease. Mortality by European region was: SMR 1.19 (CI 0.91-1.53) for the north and SMR 0.82 (CI 0.45-1.37) for the south. CONCLUSIONS: Higher mortality was not found in UC patients 10 years after disease onset. However, a significant rise in SMR for pulmonary disease, and a trend towards an age-related rise in SMR, was observed.