Regional Trends in Inflammatory Bowel Disease-Related Mortality in the US from 1999 to 2022

Inflammatory bowel disease (IBD) is a grouping of chronic inflammatory diseases of the gastrointestinal tract that affects upwards of 2.4 million Americans. Despite its prevalence, the exact cause remains unknown. This study aims to identify geographical differences in IBD-related mortality.

We utilized Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. IBD-related death and population size data over the span of 1999 to 2022 was extracted. Data was stratified by United States census regions, place of death, and gender. Crude and age-adjusted mortality rates (AAMR) were calculated and trends in mortality were modeled using the Join-point Regression Program, with statistically significant outcomes (p-value ≤ 0.05) denoted via an asterisk (*).

During the interval from 1999 to 2022, there were a total of 71,628 deaths due to Inflammatory Bowel Disease (IBD) in the United States. All census regions showed an increase in AAMR over the study period. The Midwest had the highest AAMRs with 1.54 (95% CI 1.42 to 1.65) in 1999 and rising to 1.99 (95% CI 1.87 to 2.11) in 2022 with an AAPC of 1.57 (95% CI 0.75 to 2.14)* and an APC of 9.83 (95% CI 3.43 to 21.10)* from 2018 to 2022. More specifically, Midwestern males displayed the highest AAMR with 1.74 (95% CI 1.54 to 1.94) in 1999 and 2.09 (95% CI 1.9 to 2.27) in 2022, and an APC of 8.50 (95% CI 2.254 to 19.40)* between 2018 and 2022.

Persistent regional differences were seen in IBD mortality, with the Midwest having the highest AAMR and Southern states exhibiting the greatest regional increase in AAMR over the past two decades. IBD mortality worsened across all regions during the period of the COVID-19 pandemic.