S1584 Food Swamps and Food Deserts Impact on Inflammatory Bowel Disease-Related Mortality Across US Counties

Introduction: The role of food environments in inflammatory bowel disease (IBD) outcomes remains under-explored. While food deserts and swamps are linked to metabolic diseases, their association with IBD-related mortality is unclear. Methods: We performed a cross-sectional ecological analysis of United States (US) states using publicly available Centers for Disease Control mortality data (1999–2020) and United States Department of Agriculture Food Environment Atlas metrics. Age-adjusted IBD mortality rates were calculated and analyzed alongside 2015 food desert (area lacking accessible, nutritious food) prevalence and 2016 food swamp density (fast-food restaurants per 1,000 residents). States were stratified into quartiles by mortality rates. Associations were assessed using linear regression. Results: A total of 19 US states with complete data were analyzed. The average IBD-related mortality rate was 0.22 deaths per 100,000 persons. States were divided into quartiles by mortality rate. There was no significant difference in food desert prevalence across quartiles (Q1: 20.2%, Q4: 18.9%, P = NS). However, food swamp exposure was slightly lower in higher mortality states (Q1 mean 0.63 vs Q4 mean 0.54). Linear regression showed a nonsignificant inverse trend between food swamp density and IBD mortality (β = –0.42, P = 0.10), while food desert percentage was not associated with mortality (P = 0.99). These results remained consistent after adjusting for both environmental metrics. Conclusion: Contrary to hypothesized trends, food swamp exposure was lower, not higher in states with higher IBD mortality. These findings challenge conventional assumptions and underscore the need for more granular, patient-level data to understand how food environments may shape IBD outcomes.