Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 28;30(20):2677-2688.
doi: 10.3748/wjg.v30.i20.2677.

Excess non-COVID-19-related mortality among inflammatory bowel disease decedents during the COVID-19 pandemic

Sarah Rotondo-Trivette  1 , Xin-Yuan He  2 , Jamil S Samaan  3 , Fan Lv  4 , Emily Truong  3 , Michaela Juels  5 , Anthony Nguyen  5 , Xu Gao  2   6 , Jian Zu  4 , Yee Hui Yeo  3 , Fan-Pu Ji  2   7   8 , Gil Y Melmed  9
Affiliations

Excess non-COVID-19-related mortality among inflammatory bowel disease decedents during the COVID-19 pandemic

Sarah Rotondo-Trivette et al. World J Gastroenterol. .

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare in the United States.

Aim: To investigate COVID-19-related and non-COVID-19-related death and characteristics associated with excess death among inflammatory bowel disease (IBD) decedents.

Methods: We performed a register-based study using data from the National Vital Statistics System, which reports death data from over 99% of the United States population, from January 1, 2006 through December 31, 2021. IBD-related deaths among adults 25 years and older were stratified by age, sex, race/ethnicity, place of death, and primary cause of death. Predicted and actual age-standardized mortality rates (ASMRs) per 100000 persons were compared.

Results: 49782 IBD-related deaths occurred during the study period. Non-COVID-19-related deaths increased by 13.14% in 2020 and 18.12% in 2021 [2020 ASMR: 1.55 actual vs 1.37 predicted, 95% confidence interval (CI): 1.26-1.49; 2021 ASMR: 1.63 actual vs 1.38 predicted, 95%CI: 1.26-1.49]. In 2020, non-COVID-19-related mortality increased by 17.65% in ulcerative colitis (UC) patients between the ages of 25 and 65 and 36.36% in non-Hispanic black (NHB) Crohn's disease (CD) patients. During the pandemic, deaths at home or on arrival and at medical facilities as well as deaths due to neoplasms also increased.

Conclusion: IBD patients suffered excess non-COVID-19-related death during the pandemic. Excess death was associated with younger age among UC patients, and with NHB race among CD patients. Increased death at home or on arrival and due to neoplasms suggests that delayed presentation and difficulty accessing healthcare may have led to increased IBD mortality.

Keywords: COVID-19; Crohn’s disease; Disparities; Excess death; Inflammatory bowel disease; Race; Sex; Ulcerative colitis.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: Melmed GY discloses position as consultant/advisor to: Abbvie, Arena Pharmaceuticals, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Genentech, Gilead, Ferring, Fresenius Kabi, Janssen, Oshi, Pfizer, Prometheus Labs, Samsung Bioepis, Takeda, Techlab. Ji FP discloses position as consultant/advisor to: Gilead Sciences, MSD, and speaker to: Gilead Sciences, MSD and Ascletis. All other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Observed coronavirus disease 2019-related, non-coronavirus disease 2019-related, and predicted age-standardized mortality rate trends among inflammatory bowel disease, ulcerative colitis, and Crohn’s disease decedents from 2006 to 2021. A-C: Trends in age-standardized mortality rate (ASMR) per 100000 persons are shown among inflammatory bowel disease (A), ulcerative colitis (B), and Crohn’s disease decedents (C). Error bars represent the 95% confidence intervals for predicted ASMR. ASMR: Age-standardized mortality rate; COVID-19: Coronavirus disease 2019.
Figure 2
Figure 2
Observed coronavirus disease 2019-related, non-coronavirus disease 2019-related, and predicted age-standardized mortality rate trends among Crohn’s disease and ulcerative colitis decedents stratified by age from 2006 to 2021. A-D: Trends in age-standardized mortality rate (ASMR) per 100000 persons are shown among Crohn’s disease (CD) decedents age 25-64 (A), CD decedents age ≥ 65 (B), ulcerative colitis (UC) decedents age 25-64 (C), and UC decedents age ≥ 65 (D). Error bars represent the 95% confidence intervals for predicted ASMR. ASMR: Age-standardized mortality rate; COVID-19: Coronavirus disease 2019.
Figure 3
Figure 3
Observed coronavirus disease 2019-related, non-coronavirus disease 2019-related, and predicted age-standardized mortality rate trends among Crohn’s disease and ulcerative colitis decedents stratified by race/ethnicity from 2006 to 2020. A-D: Trends in age-standardized mortality rate (ASMR) per 100000 persons are shown among Hispanic Crohn’s disease (CD) decedents (A), non-Hispanic white CD decedents (B), non-Hispanic black CD decedents (C), Hispanic ulcerative colitis (UC) decedents (D), non-Hispanic white UC decedents (E), and non-Hispanic black UC decedents (F). Error bars represent the 95% confidence intervals for predicted ASMR. ASMR: Age-standardized mortality rate; COVID-19: Coronavirus disease 2019.
Figure 4
Figure 4
Observed coronavirus disease 2019-related, non-coronavirus disease 2019-related, and predicted age-standardized mortality rate trends among inflammatory bowel disease decedents by place of death from 2006 to 2021. A-D: Trends in age-standardized mortality rate (ASMR) per 100000 persons are shown among inflammatory bowel disease decedents according to the place of death: At home or on arrival (A), medical facility (B), nursing home (C), and hospice facility (D). 1Indicates observed value less than predicted value. Error bars represent the 95% confidence intervals for predicted ASMR. ASMR: Age-standardized mortality rate; COVID-19: Coronavirus disease 2019.
Figure 5
Figure 5
Age-standardized mortality rate trends among ulcerative colitis and Crohn’s disease decedents by top three causes of death from 2006 to 2021. A and B: Trends in age-standardized mortality rate per 100000 persons are shown among the top three causes of death of Crohn’s disease decedents (A) and ulcerative colitis decedents (B). ASMR: Age-standardized mortality rate.
See this image and copyright information in PMC

References

    1. CDC Deaths by Week and State - Provisional Death Counts for COVID-19. [cited 10 August 2023]. Available from: https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm .
    1. COVID-19 Excess Mortality Collaborators. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet. 2022;399:1513–1536. - PMC - PubMed
    1. Shiels MS, Almeida JS, García-Closas M, Albert PS, Freedman ND, Berrington de González A. Impact of Population Growth and Aging on Estimates of Excess U.S. Deaths During the COVID-19 Pandemic, March to August 2020. Ann Intern Med. 2021;174:437–443. - PMC - PubMed
    1. Banerjee A, Chen S, Pasea L, Lai AG, Katsoulis M, Denaxas S, Nafilyan V, Williams B, Wong WK, Bakhai A, Khunti K, Pillay D, Noursadeghi M, Wu H, Pareek N, Bromage D, McDonagh TA, Byrne J, Teo JTH, Shah AM, Humberstone B, Tang LV, Shah ASV, Rubboli A, Guo Y, Hu Y, Sudlow CLM, Lip GYH, Hemingway H. Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic. Eur J Prev Cardiol. 2021;28:1599–1609. - PMC - PubMed
    1. Yeo YH, He X, Ting PS, Zu J, Almario CV, Spiegel BMR, Ji F. Evaluation of Trends in Alcohol Use Disorder-Related Mortality in the US Before and During the COVID-19 Pandemic. JAMA Netw Open. 2022;5:e2210259. - PMC - PubMed

MeSH terms

LinkOut - more resources