Temporal Trends in Mortality Related to Crohn’s Disease in the United States

Background: Crohn’s disease is a chronic and debilitating inflammatory bowel disease that affects many people worldwide. This study explores mortality trends associated with Crohn’s disease across various age groups, racial and ethnic backgrounds, urban and suburban settings, and census regions. Goals: By examining age-adjusted mortality rates (AAMRs), we identified the disparities in Crohn’s disease-related mortality within demographic and geographic categories of the United States. Study: We analyzed death certificates from the CDC WONDER database (1999 to 2020), calculating AAMR per million people and annual percent change (APC) with 95% CIs. Trends by race, ethnicity, gender, age, census regions, and 2013 urbanization status were assessed using the Joinpoint Regression Program. Results: Between 2018 and 2020, Crohn’s disease-related AAMRs rose sharply (APC 11.18, P =0.03). Most deaths occurred in medical inpatient settings (AAPC 0.228), but fatalities at home significantly increased (AAPC 5.37). After 2018, mortality rose in both men (APC 13.21) and women (APC 10.24). The Midwest had the highest rates (APC 0.56, P =0.04), while the Northeast saw a decline (1999 to 2017) followed by a sharp rise after 2017 (APC 9.64, P =0.0071). Mortality was higher in Whites but rose significantly in both Whites (APC 10.47) and African Americans (APC 20.62) post-2018, while trends among Hispanics showed no significant change. Conclusions: Marked demographic and geographic disparities, particularly the wide gap in AAMRs between Whites and African Americans, underscore the urgent need for targeted interventions, improved access to care, and more comprehensive research to reduce these inequities and enhance patient outcomes.