C0398 - Excess Non-COVID Mortality Among IBD Decedents During the COVID-19 Pandemic

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Sarah Rotondo-Trivette, MD

Cedars-Sinai Medical Center
Los Angeles, CA

Emily Truong, MD¹, Sarah Rotondo-Trivette, MD¹, Jamil S. Samaan, MD¹, Yee Hui Yeo, MD¹, Xinyuan He, MD², Fan Lv, ³, Anthony Nguyen, ⁴, Michaela Juels, ⁴, Fanpu Ji, MD², Gil Y. Melmed, MD¹
¹Cedars-Sinai Medical Center, Los Angeles, CA; ²The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shanxi, China; ³School of Mathematics and Statistics, Xi’an Jiaotong University, Xi'an, Shanxi, China; ⁴David Geffen School of Medicine at UCLA, Los Angeles, CA

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 1A). In subgroup analyses (Table 1), 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 1B). 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 1C). 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 1).

Discussion: 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: 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.

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]

Table: Table 1: Subgroup Analyses of Observed COVID, Non-COVID, and Predicted Age-Standardized Mortality Rates Among IBD Decedents
*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.

Disclosures:

Emily Truong indicated no relevant financial relationships.

Sarah Rotondo-Trivette indicated no relevant financial relationships.

Jamil Samaan indicated no relevant financial relationships.

Yee Hui Yeo indicated no relevant financial relationships.

Xinyuan He indicated no relevant financial relationships.

Fan Lv indicated no relevant financial relationships.

Anthony Nguyen indicated no relevant financial relationships.

Michaela Juels indicated no relevant financial relationships.

Fanpu Ji: Gilead Sciences – Advisory Committee/Board Member, Consultant, Speakers Bureau. MSD – Advisory Committee/Board Member, Consultant, Speakers Bureau.

Gil Melmed: AbbVie – Consultant. Arena – Consultant. Boehringer Ingelheim – Consultant. Bristol Meyers Squibb – Advisor or Review Panel Member, Consultant. Entasis – Consultant. Janssen – Consultant. Medtronic – Consultant. Pfizer – Consultant, Grant/Research Support. Samsung Bioepis – Consultant. Shionogi – Advisor or Review Panel Member. Takeda – Consultant. TechLab – Consultant.

Emily Truong, MD¹, Sarah Rotondo-Trivette, MD¹, Jamil S. Samaan, MD¹, Yee Hui Yeo, MD¹, Xinyuan He, MD², Fan Lv, ³, Anthony Nguyen, ⁴, Michaela Juels, ⁴, Fanpu Ji, MD², Gil Y. Melmed, MD¹. C0398 - Excess Non-COVID Mortality Among IBD Decedents During the COVID-19 Pandemic, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.