Abstract WE448: Escalating Cardiovascular Mortality in Inflammatory Bowel Disease: A 22-Year National Analysis Revealing Alarming Geographic, Rural-Urban, and Racial Disparities in the United States, 1999-2020

Background: Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, is increasingly linked to cardiovascular disease (CVD) through systemic inflammation, endothelial dysfunction, and treatment-related metabolic effects. Yet, long-term population-level trends and disparities in IBD-related cardiovascular mortality remain underexplored. Methods: We analyzed national mortality data from CDC WONDER (1999–2020), identifying deaths with IBD (ICD-10 K50–K51) as a contributing cause and CVD (I00–I99) as the underlying cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, and temporal trends were quantified using Joinpoint regression to estimate Average Annual Percent Change (AAPC). Trends were stratified by region, urbanization, age, sex, race, and Hispanic origin. Results: A total of 11,891 deaths were recorded nationally, with mortality rising from 0.21 to 0.22 per 100,000 (AAPC +1.0%, 95% CI 0.3–1.7; p<0.05). A 22.5% spike occurred in 2020 (723 vs 590 deaths in 2019). Regionally, the South recorded 3,660 deaths (30.8%) and the steepest rise (AAPC +1.9%), while the Northeast declined (AAPC –0.8%). Rurality showed a strong inverse gradient: large central metros declined (AAPC –1.2%), but rural noncore counties rose +2.8%, representing a 4-fold disparity. Age-specific trends showed increasing mortality in 55–64 years (1,427 deaths; 0.19/100,000) despite declines in older cohorts. Females accounted for 6,409 deaths (53.9%) with AAPC +0.4%, whereas males (5,482 deaths) had AAPC +1.2%, tripling the female growth rate. Racial gaps widened: White 11,069 (93.1%, AAPC +1.8%), Black 684 (5.8%, AAPC +5.2%), Asian/Pacific Islander 95 (0.8%, +3.1%), and American Indian/Alaska Native 43 (0.4%). Black Americans had 2.9-fold higher AAPC than Whites. Hispanic populations (276 deaths; AAPC +2.4%) showed 2.7-fold faster increases than non-Hispanics. Conclusions: From 1999–2020, IBD-related CVD mortality increased +1.0% annually, with three intersecting disparities: geographic (South +1.9%), rural–urban (+2.8% vs –1.2%), and racial (Black +5.2%). The 2020 surge highlights vulnerability during systemic crises. Rising deaths among 55–64-year-olds suggest premature cardiovascular aging in IBD. These findings call for integrated IBD–cardiology care, rural and minority-focused interventions, and mechanistic studies into inflammation-accelerated atherosclerosis.