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. 2025 Jan 2:18:17562848241311006.
doi: 10.1177/17562848241311006. eCollection 2025.

Increased gastrointestinal bleeding-related mortality during the COVID-19 pandemic

Xu Gao  1 , Yee Hui Yeo  2 , Fan Lv  3 , Xinyuan He  4 , Justin Park  5 , Jamil Samaan  3 , Yunyu Zhao  4 , Wee Han Ng  6 , Jinhai Wang  1 , Fanpu Ji  7 , Gil Y Melmed  8
Affiliations

Increased gastrointestinal bleeding-related mortality during the COVID-19 pandemic

Xu Gao et al. Therap Adv Gastroenterol. .

Abstract

Background: Despite its significant health burden, there is a lack of national-level temporal patterns in gastrointestinal bleeding (GIB) mortality.

Objectives: To comprehensively decipher the annual and monthly trend of GIB-related mortality in the United States.

Design: Cross-sectional study.

Methods: We analyzed the National Vital Statistic System database, which documents more than 99% of the annual deaths in the United States for GIB-related deaths from January 2010 to May 2023. Annual and monthly age-standardized mortality rates were estimated and categorized by age, sex, and bleeding site. Joinpoint regression was performed for trend analysis. Prediction modeling was conducted to determine the GIB-associated excess mortality.

Results: A total of 529,094 and 210,641 GIB-associated deaths occurred before and after 2020, respectively. Following a stably decreasing trend between 2010 and 2019, there was an excess mortality rate during the pandemic which peaked in 2021. The monthly mortality trend showed spikes corresponding to the outbreak of variants. Importantly, excess GIB-related mortality resolved in 2023, with the convergence of predicted and observed mortality rates. Subgroup analysis showed that young males (aged 19-44 years) were affected the most during the pandemic, with excess mortality rates of 35.80%, 52.77%, and 31.46% in 2020, 2021, and 2022, respectively. While the increasing trend of upper GIB was accentuated during the pandemic, lower GIB showed a reversal of the pre-pandemic decreasing trend.

Conclusion: Our findings demonstrate the trend of GIB-related mortality, underscoring an increased excess death during the pandemic followed by a resolution in 2023. We identify subpopulations vulnerable to the pandemic.

Keywords: COVID-19 outbreak impact; age-standardized mortality rates; annual percentage change; gastrointestinal hemorrhage trends; public health.

Plain language summary

Increased gastrointestinal bleeding-related mortality during the COVID-19 pandemic Why was the study done? While the COVID-19 pandemic has incurred substantial gastrointestinal (GI)-related excess mortality, the detailed temporal trends throughout the pandemic’s duration remain unclear. What did the researchers do? Using a nationwide mortality database, we identified deaths related to GI bleeding that occurred between January 2010 and May 2023. What did the researchers find? A total of 529,094 and 210,641 GI bleeding-associated deaths occurred before and during the pandemic, respectively. The annual excess mortality rate peaked in 2021 and declined in 2022. The monthly mortality trend showed spikes corresponding to the outbreak of new variants. Importantly, excess GI bleeding-related mortality resolved in 2023, with the convergence of predicted and observed mortality rates. Subgroup analysis showed that young males (aged 19-44 years) were affected the most during the pandemic, with excess mortality rates of 35.80%, 52.77%, and 31.46% in 2020, 2021, and 2022, respectively. While the increasing trend of upper GI bleeding was accentuated during the pandemic, lower GI bleeding showed a reversal of the pre-pandemic decreasing trend. What do the findings mean? Our findings demonstrate the resolution of excess GI bleeding-related mortality in 2023 and identify subpopulations vulnerable to the pandemic. It has implications for policymakers in addressing the current pandemic and preparing for future pandemics.

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Conflict of interest statement

Fanpu Ji discloses position as consultant/advisor to: Gilead Sciences, MSD, and speaker to: Gilead Sciences, MSD and Ascletis. Gil Y. Melmed 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 All other authors do not have conflict of interest.

Figures

Figure 1.
Figure 1.
Temporal trend for ASMRs of gastrointestinal bleeding-related death in the United States. (a) Annual ASMR. Shaded areas denote the difference between the observed and predicted ASMRs for 2020–2022. (b) Monthly ASMR. Periods of outbreaks secondary to wild-type SARS-CoV-2 and its variants were denoted as different color-shaded areas. ASMRs, age-standardized mortality rates.
Figure 2.
Figure 2.
Annual trend for ASMRs of gastrointestinal bleeding-related death in the United States. The shaded area in yellow color in both panels denotes the pandemic. (a) By age. Shaded areas in orange, red, and green colors denote the difference between the observed and predicted ASMRs for age groups 19–44 years, 45–64 years, and ⩾65 years, respectively. (b) By sex. Shaded areas in blue and red colors denote the difference between the observed and predicted ASMRs for males and females, respectively. ASMRs, age-standardized mortality rates.
Figure 3.
Figure 3.
Annual trend for ASMRs of gastrointestinal bleeding-related death in the United States by the location of bleeding. The shaded area in yellow color in both panels denotes the pandemic. Shaded areas in orange and blue colors denote the difference between the observed and predicted ASMRs for the upper and lower gastrointestinal tracts, respectively. ASMRs, age-standardized mortality rates.
Figure 4.
Figure 4.
Annual trend for ASMRs of gastrointestinal bleeding-related death in the United States by the etiologies of bleeding. The shaded area in yellow color in both panels denotes the pandemic. The definition of each etiology is elucidated in Supplemental Table 1. ASMRs, age-standardized mortality rates.
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