SummaryBackgroundScottish nationwide linkage data from 1998 to 2000 demonstrated high 3‐year mortality in patients hospitalised with ulcerative colitis (UC).AimTo compare 3‐year mortality, and factors related to mortality, in Scottish patients hospitalised with UC between 1998–2000 and 2007–2009.MethodsThe Scottish Morbidity Records and linked datasets were used to assess 3‐year mortality, standardised mortality ratio (SMR) and multivariate analyses of factors associated with 3‐year mortality. The 3‐year mortality was determined after four admission types: surgery‐elective or emergency; medical‐elective or emergency.Age‐standardised mortality rates (ASR) were used to compare mortality rates between periods.ResultsUlcerative colitis admissions increased from 10.6 in Period 1 to 11.6 per 100 000 population per year in Period 2 (P = 0.046). Crude and adjusted 3‐year mortality fell between time periods (crude 12.2% to 8.3%; adjusted OR 0.59, CI 0.42–0.81, P = 0.04). Adjusted 3‐year mortality following emergency medical admission (OR 0.58, CI 0.39–0.87, P = 0.003) and in patients >65 years (38.8% to 28.7%, P = 0.02) was lower in Period 2. The SMR in period 1 was 3.04 and 2.96 in Period 2. Directly age‐standardised mortality decreased from 373 (CI 309–437) to 264 (CI 212–316) per 10 000 person‐years. On multivariate analysis, increasing age (50–64 years OR 7.11 (CI 2.77–18.27, P < 0.05); 65–74 years OR 14.70 (CI 5.65–38.25 P < 0.05); >75 years OR 46.42 (CI 18.29–117.78, P < 0.001) and co‐morbidity (OR 3.02, CI 1.72–5.28, P < 0.001) were significantly associated with 3‐year mortality in Period 2.ConclusionsComparisons of crude and adjusted mortality rates suggest significant improvement in outcome over the last decade – however, mortality remains high, and older age and co‐morbidity are important predictors of outcome.