Background/Purpose: Almost every organ system can be affected by immune-mediated inflammatory diseases (IMID) characterized by inflammation and therapeutic response to immune-suppressive or anti-inflammatory drugs. Since IMID are purported to have shared pathogenic mechanisms, it would be important to understand their burden of disease together. Our goal is to determine 1) the burden of IMID deaths relative to the leading causes of death published by the Centers for Disease Control and Prevention (CDC) and 2) the mortality associations of IMID with major demographic/geographic variables.

Methods: This is a nationwide population-based study using a U.S. national mortality database and census data from 2013 to 2017. A list of forty-four IMID was compiled based on their relative high prevalence. Crude death rates for each IMID were calculated by dividing death counts of each IMID by the U.S. population between 2013 and 2017 and ranked. Pooled death counts of the fifteen IMID with highest crude death rates were further ranked among CDC’s official leading-causes-of-death ranklist for eleven age groups and charted. Mortality associations with four demographic/geographic variables were analyzed with multinomial logistic regression.

Results: 362,150 deaths were attributed to the top fifteen IMID from 2013 to 2017. Of these deaths, IMID were recorded as the underlying cause in 202,430 deaths and as the contributing cause in 159,720 deaths. These IMID deaths (underlying + contributing) ranked 6th to 9th for all age groups in relation to the CDC’s official leading causes of death. The ranking was even higher in Black persons, particularly in young females. IMID deaths ranked number 4 in Black females at 35-54 age groups. Multinomial logistic regression analysis revealed that young (< 45 years) and middle (45-64 years) ages, female sex, race/ethnicity of non-Hispanic Black or American Indian/Alaska Native, and census region of West or Midwest were independently associated with higher IMID mortality. IMID caused premature mortality in several race/ethnic groups, especially in Blacks and American Indians/Alaska Natives. American Indians/Alaska Natives living in the Midwest or West had the highest risk for IMID mortality.

Conclusion: IMID is an unrecognized leading cause of death. IMID caused premature mortality, especially in Black females, and in American Indians/Alaska Natives living in the Midwest and West. These data highlight that IMID is a major public health problem. Similar to various forms of cancer, various IMIDs should be considered as a collective disease entity. The recognition of IMID as a leading cause of death may influence healthcare prioritization and research funding, which may help to reduce their disease burden. Our data have implications for developing precision public health strategies to target IMID high-risk vulnerable populations including Black females and American Indians/Alaska Natives living in the Midwest and West.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-burden-of-immune-mediated-inflammatory-diseases-imid-race-ethnicity-sex-and-geographic-variation-in-the-united-states/