National Trends and Disparities in Inflammatory Bowel Disease Mortality in the United States, 1999-2020

Abstract BACKGROUND Inflammatory bowel disease (IBD), comprising ulcerative colitis and Crohn’s disease, remains a significant public health concern in the United States. While therapeutic advances have improved disease management, long-term mortality patterns remain incompletely characterized. METHODS We analyzed national mortality data from the CDC WONDER database (1999–2020). Deaths with IBD as the underlying cause were identified using ICD-10 codes Crohn’s disease and ulcerative colitis. We calculated crude mortality rates per 100,000 population from deaths and population denominators, and estimated temporal trends using log-linear regression to obtain annual percent change (APC) with 95% confidence intervals (CIs). Subgroup analyses were performed by census region, 2013 urbanization, ten-year age groups, sex, race, and Hispanic origin. Result From 1999–2020, there were 20,376 IBD deaths nationally. The crude mortality rate increased from 0.286 per 100,000 in 1999 to 0.340 per 100,000 in 2020, corresponding to a significant overall APC of + 0.45% (95% CI 0.14–0.76; p = 0.01). By region, mortality rose in the West (+1.19%, 0.61–1.77; p 0.001) and South (+0.41%, 0.06–0.77; p = 0.03), was borderline in the Midwest (+0.41%, 0.01–0.81; p = 0.06), and stable in the Northeast (–0.07%, –0.62 to 0.48; p = 0.80). By 2013 urbanization, the steepest rise occurred in medium metro areas (+1.06%, 0.55–1.58; p 0.001); micropolitan (+0.82%, 0.02–1.62; p = 0.06) was borderline, while other categories were not significant. Age-specific patterns showed significant declines among 75–84 years (–1.18%, –1.58 to –0.77; p 0.001) and ≥85 years (–1.05%, –1.50 to –0.60; p 0.001), with non-significant changes in younger groups. By sex, mortality increased in males (+0.97%, 0.61–1.33; p 0.001) but not females (+0.07%, –0.36 to 0.51; p = 0.75). By race, significant rises were observed in Black (+1.28%, 0.68–1.88; p 0.001) and White (+0.56%, 0.24–0.89; p 0.001) populations, while Asian/Pacific Islander (–2.26%, –10.53 to 6.78; p = 0.65) was not significant; by ethnicity, non-Hispanic (+0.74%, 0.40–1.07; p 0.001) increased, whereas Hispanic (+0.63%, –0.40 to 1.67; p = 0.25) did not. CONCLUSION Overall, IBD mortality rose modestly over two decades, with higher increases among men, Black and White populations, and residents of the South, West, and medium metro areas, in contrast to declines among the oldest adults. These findings highlight persistent demographic and geographic disparities and support targeted strategies to improve equitable access to effective therapies and comprehensive care.