Who bears the brunt? Geographic, racial and ethnic disparities in mortality trends of inflammatory bowel disorders in the United States

Background: Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease (CD), presents increasing global health burdens. Despite advancements in therapy, disparities in mortality trends across demographic and geographic lines persist in the United States. Objective: To analyze IBD-associated mortality trends in the U.S. from 2018 to 2023 using CDC WONDER data, highlighting demographic, regional, and sex-based disparities. Methods: A retrospective analysis of death certificate data from the CDC WONDER database was performed. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, and region. Trends were evaluated via join-point regression, with the annual percentage change (APC) and average annual percentage change (AAPC) calculated to assess statistical significance. Results: A total of 25,153 IBD-related deaths were recorded. The AAMR increased from 8.269 (2018) to 10.761 (2023), with a notable increase until 2022 (APC: +8.91), followed by a decline in 2023 (APC: -7.55). Men presented higher AAMRs than women did (10.882 vs. 9.838). Non-Hispanic White individuals had the highest AAMR (11.401), whereas Non-Hispanic Black and Asian populations presented the steepest increases (APC: 10.49 and 13.45, respectively). Regionally, the Midwest had the highest AAMR (11.531), with Oregon demonstrating the highest state-level mortality. Conclusions: This study reveals increasing IBD mortality in the U.S., with significant sex, racial, and geographic disparities. These findings highlight systemic inequities in healthcare access, particularly in access to biologic therapy and specialty care. Targeted public health strategies are crucial for reducing disparities and enhancing outcomes in high-risk populations.