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Excess non-COVID-19-related mortality among inflammatory bowel disease decedents during the COVID-19 pandemic
Sarah Rotondo-Trivette1, Xin-Yuan He2, Jamil S Samaan3
1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
Insights
Inflammatory bowel disease (IBD) patients experienced increased non-COVID-19 deaths during the pandemic. This excess mortality was linked to younger age in ulcerative colitis and non-Hispanic Black race in Crohn's disease.
Area of Science:
- Gastroenterology and Epidemiology
- Public Health and Mortality Studies
- Inflammatory Bowel Disease (IBD) Research
Background:
- The COVID-19 pandemic significantly disrupted healthcare systems across the United States.
- Understanding the impact on vulnerable populations, such as those with Inflammatory Bowel Disease (IBD), is crucial.
Purpose of the Study:
- To analyze COVID-19-related and non-COVID-19-related mortality among IBD decedents.
- To identify characteristics associated with excess deaths in the IBD population during the pandemic.
Main Methods:
- A register-based study utilized the National Vital Statistics System (NVSS) data from 2006-2021.
- IBD-related deaths in adults (≥25 years) were analyzed, stratified by demographics and primary cause of death.
- Predicted versus actual age-standardized mortality rates (ASMRs) were compared.
Main Results:
- A total of 49,782 IBD-related deaths were recorded during the study period.
- Non-COVID-19-related deaths increased by 13.14% in 2020 and 18.12% in 2021 compared to predictions.
- Significant increases in non-COVID-19 mortality were observed in younger ulcerative colitis patients and non-Hispanic Black Crohn's disease patients. Deaths due to neoplasms and at home/on arrival also rose.
Conclusions:
- IBD patients experienced excess non-COVID-19-related mortality during the pandemic.
- Excess death was associated with younger age in ulcerative colitis and non-Hispanic Black race in Crohn's disease.
- Findings suggest delayed healthcare access and presentation may have contributed to increased IBD mortality.
Background:
The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare in the United States.
Aim:
To investigate COVID-19-related and non-COVID-19-related death and characteristics associated with excess death among inflammatory bowel disease (IBD) decedents.
Methods:
We performed a register-based study using data from the National Vital Statistics System, which reports death data from over 99% of the United States population, from January 1, 2006 through December 31, 2021. IBD-related deaths among adults 25 years and older were stratified by age, sex, race/ethnicity, place of death, and primary cause of death. Predicted and actual age-standardized mortality rates (ASMRs) per 100000 persons were compared.
Results:
49782 IBD-related deaths occurred during the study period. Non-COVID-19-related deaths increased by 13.14% in 2020 and 18.12% in 2021 [2020 ASMR: 1.55 actual vs 1.37 predicted, 95% confidence interval (CI): 1.26-1.49; 2021 ASMR: 1.63 actual vs 1.38 predicted, 95%CI: 1.26-1.49]. In 2020, non-COVID-19-related mortality increased by 17.65% in ulcerative colitis (UC) patients between the ages of 25 and 65 and 36.36% in non-Hispanic black (NHB) Crohn's disease (CD) patients. During the pandemic, deaths at home or on arrival and at medical facilities as well as deaths due to neoplasms also increased.
Conclusion:
IBD patients suffered excess non-COVID-19-related death during the pandemic. Excess death was associated with younger age among UC patients, and with NHB race among CD patients. Increased death at home or on arrival and due to neoplasms suggests that delayed presentation and difficulty accessing healthcare may have led to increased IBD mortality.
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