Background/Purpose: The United States makes a significant contribution to Inflammatory Bowel Disease (IBD) related disease burden worldwide. However, data on geographic variability of IBD related mortality within the United States is scarce. Our study assessed the trends in IBD related mortality stratified by geographic pattern through states and metropolitan-nonmetropolitan designation from 1999 to 2019.

Methods: We used Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. IBD related deaths, age >/=25 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. AAMR was stratified by states and metropolitan-nonmetropolitan designation. Annual percentage changes (APC) were calculated to examine changes in trends using joinpoint regression.

Results: The AAMR per 100,000 population from 1999 to 2019 was 1.29. Crohn’s Disease had a higher AAMR compared with Ulcerative Colitis, (0.83 vs 0.53, respectively). The states with the highest AAMR included Oregon (2.21), Vermont (2.19), Rhode Island (1.98), Nebraska (1.81), and Oklahoma (1.78). The lowest AAMRs were seen in Hawaii (0.53), Louisiana (0.8), District of Columbia (0.97), New Mexico (0.98) and Arizona (0.98). Non-metropolitan areas had a higher AAMR compared with metropolitan areas from 1999 to 2019 (1.37 vs 1.28, respectively). Amongst non-metropolitan designations, there was a rise in AAMR (1.28 vs 1.49) from 1999 to 2019 (APC 0.8 [95% CI, 0.5 to 1.1]), whereas in metropolitan counties AAMR decreased from 1999 to 2019 (APC -0.3 [95% CI, -0.6 to 0.0]).

Conclusion: Our study demonstrated considerable geographic variation in regards to IBD-related mortality. Overall higher mortality rates were seen in non-metropolitan versus metropolitan areas, along with a rise in mortality trends within non-metropolitan areas. The geographic disparity in mortality determined by our study highlights the need for robust monitoring of patients in these locations, reevaluation of state level health policies, as well as investigation of risk factors leading to these discrepancies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/geographic-variability-of-inflammatory-bowel-disease-related-mortality-1999-2019-cdc-wonder/