S1668 Global Trends and Disparities in Inflammatory Bowel Disease-Related Mortality: A Systematic Review of the Past Two Decades

Introduction: Inflammatory bowel disease (IBD) is a chronic disorder of the gastrointestinal tract that includes Crohn's Disease (CD) and Ulcerative Colitis (UC), which has traditionally been considered a chronic but non-fatal condition. However, emerging data suggest a shifting landscape in IBD-related mortality, with potential increases in burden driven by demographic, socioeconomic, and geographic disparities. This systematic review evaluates global IBD mortality trends from 2004 to 2024, with a focus on regional patterns and inequities related to sex, race, socioeconomic status, healthcare access, and treatment. Methods: A systematic literature search was conducted across PubMed, Scopus, and Web of Science using standardized PRISMA guidelines. From 1,200 initial records, 38 studies met inclusion criteria, providing quantitative mortality outcomes and demographic or geographic stratifications. Data were synthesized thematically, supplemented by estimates from the Global Burden of Disease (GBD) 2017 and 2019 studies. Results: Global age-standardized IBD mortality rates declined modestly from 0.56 to 0.54 deaths per 100,000 between 2017–2019, alongside a slight decrease in prevalence. However, regional disparities were striking: mortality increased in Central and Eastern Europe, Central Asia, and Latin America, while prevalence simultaneously declined. In contrast, high-income regions exhibited stable or reduced mortality despite rising incidence. Disparities by gender, socioeconomic status, and race were also notable. Males and individuals of lower socioeconomic status had higher mortality risks, likely due to reduced access to advanced treatments. Racial minorities in the U.S. demonstrated poorer outcomes and lower biologic utilization. Forecasts from GBD 2021 predict a reversal of mortality declines, with rates projected to rise to 0.81 per 100,000 by 2050. Conclusion: Despite modest global progress, IBD-related mortality is increasingly shaped by structural inequities. The uneven uptake of biologics and small-molecule therapies, compounded by insurance restrictions and healthcare fragmentation, reinforces these trends. Addressing disparities in early diagnosis, access to effective treatment, and public health interventions is crucial for reversing the projected increase in mortality and improving outcomes in marginalized populations.