S756 Excess Non-COVID Mortality Among IBD Decedents During the COVID-19 Pandemic

Abstract

Introduction: The degree to which the pandemic has caused excess non-COVID death in IBD patients remains unclear. Methods: This serial population-based analysis included data from the CDC’s National Vital Statistics System on IBD decedents aged ≥25 years from 1/1/06 to 12/31/21. IBD was defined as Crohn’s disease (CD) or ulcerative colitis (UC). Decedents were stratified by age (25-64 vs ≥65 years), sex, race (Hispanic, non-Hispanic white, and non-Hispanic black), place of death (at home/on arrival, at a medical facility, on hospice, or in a nursing facility), and top three causes of death (diseases of the digestive system, circulatory system, or neoplasms). Age-standardized mortality rates (ASMRs) per 100,000 persons were calculated for all-cause, non-COVID, and COVID mortality. Predictive analyses were performed to predict ASMRs during the pandemic based on pre-pandemic data. Observed ASMR higher than the 95% confidence intervals of predicted ASMR was considered as statistically significant. Results: Of 30,328 IBD-related deaths from 2006-2021, 5,270 occurred from 2020-2021. 417 (7.9%) were COVID-related, and 4,853 (92.1%) were non-COVID-related. There was significant excess non-COVID death among IBD patients in 2020 (ASMR 1.55 vs 1.37, 95% CI [1.26-1.49]) and 2021 (1.63 vs 1.38, 95% CI [1.26-1.49]) (Figure A). In subgroup analyses (Table), UC patients aged 25-64 years and non-Hispanic black patients with CD had significant excess non-COVID death in 2020 (0.20 vs 0.17, 95% CI [0.15-0.19]; (0.75 vs 0.55, 95% CI 0.41-0.70). Death from neoplasms was significantly increased during the pandemic (0.30 vs 0.22, p=0.0167) (Figure B). Additionally, there were significant excess non-COVID deaths among IBD decedents at home and on arrival during the pandemic (2020: 0.61 vs 0.46, 95% CI [0.42-0.49]; 2021: 0.61 vs 0.47, 95% CI [0.43-0.51]) (Figure C). Deaths at medical facilities were also increased (2021: 0.59 vs 0.48, 95% CI [0.39-0.56]), while deaths on hospice decreased (2021: 0.14 vs 0.17, 95% CI [0.15-0.18]) (Table). Conclusion: IBD patients experienced significant excess non-COVID mortality during the pandemic. Upon subgroup stratification, young UC patients and non-Hispanic black CD patients were the most impacted. The rise in neoplasm-related non-COVID deaths and mortality rates prior to hospital arrival during the pandemic suggests that indirect effects of the pandemic, such as delayed presentation, likely exacerbated healthcare disparities and adversely impacted timely interventions and care.Figure 1.: Temporal Trends of Observed All-Cause, Non-COVID, and Predicted Age-Standardized Mortality Rates Among IBD Decedents Temporal trends in ASMR per 100,000 persons are shown among (A) all IBD decedents, (B) top 3 causes of death, and (C) deaths at home or on arrival. 95% confidence intervals are represented by error bars. ASMR=Age-Standardized Mortality Rate. COVID=coronavirus disease. IBD=inflammatory bowel disease. Table 1. - Subgroup Analyses of Observed COVID, Non-COVID, and Predicted Age-Standardized Mortality Rates Among IBD Decedents Stratification Group Year COVID ASMRs Non-COVID ASMRs Predicted ASMRs with 95% CI Age UC 25-64 years 2020 0.01 0.20* 0.17 [0.15-0.19] 2021 0.03 0.18 0.17 [0.15-0.19] ≥65 years 2020 0.28 2.31 2.30 [2.01-2.58] 2021 0.28 2.53 2.45 [2.04-2.86] CD 25-64 years 2020 0.02 0.46 0.42 [0.37-0.47] 2021 0.04 0.46 0.45 [0.38-0.52] ≥65 years 2020 0.25 2.95 2.79 [2.46-3.12] 2021 0.33 3.15 2.87 [2.49-3.25] Sex UC Male 2020 0.07 0.70 0.68 [0.62-0.75] 2021 0.09 0.69 0.70 [0.63-0.78] Females 2020 0.06 0.54 0.53 [0.44-0.61] 2021 0.07 0.60 0.57 [0.44-0.70] CD Males 2020 0.06 0.94 0.93 [0.83-1.04] 2021 0.11 0.99 1.01 [0.86-1.16] Females 2020 0.06 0.95 0.90 [0.78-1.02] 2021 0.09 0.99 0.94 [0.76-1.12] Race UC Hispanics 2020 0.04 0.26 0.23 [0.07-0.38] Non-Hispanic whites 2020 0.07 0.71 0.71 [0.63-0.78] Non-Hispanic blacks 2020 0.02 0.39 0.41 [0.29-0.52] CD Hispanics 2020 0.03 0.27 0.27 [0.08-0.47] Non-Hispanic whites 2020 0.07 1.15 1.12 [0.99-1.25] Non-Hispanic blacks 2020 0.06 0.75* 0.55 [0.41-0.70] *Signifies statistical significance ASMRs are per 100,000 persons.ASMR=Age-Standardized Mortality Rate. CD=Crohn’s Disease. CI=confidence interval. COVID=coronavirus disease. UC=Ulcerative Colitis.