S1546 Coronary Artery Disease-Related Mortality Trends in IBD Patients From 1999-2020

Introduction: Inflammatory bowel disease (IBD) is associated with systemic inflammation, a known risk factor for coronary artery disease (CAD). However, population-level mortality trends specifically linking IBD to CAD deaths remain poorly characterized. This study evaluates trends in CAD-related mortality among IBD patients in the U.S. from 1999 to 2020 and examines disparities by sex, race/ethnicity, region, and urbanization. Methods: Using CDC WONDER data, we identified deaths listing both IBD (International Classification of Diseases-50 and International Classification of Diseases-51) and CAD (International Classification of Diseases-25) among individuals aged 25–85+. Age-adjusted mortality rates (AAMRs) were calculated and stratified by demographic and geographic variables. Trends were analyzed via Join Point regression (P < 0.05). Results: Between 1999 and 2020, age-adjusted mortality rates declined significantly (APC: -6.52%). Striking drops occurred across multiple groups from 2007 to 2011. Black individuals experienced a sharp decline from 2008 to 2011 (APC: -29.48%), while White individuals saw a similar reduction from 2007 to 2010 (APC: -25.86%). Among sexes, females had a marked decline (2007–2010; APC: -27.11%), as did males (APC: -26.34%). Large central metro areas showed a steep decline from 2008 to 2011 (APC: -29.77%), and Small Metro areas declined from 2007 to 2010 (APC: -23.69%). Regionally, the Northeast experienced a sharp decline from 2007 to 2010 (APC: -29.08%) and continued to show significant reductions through 2020 (APC: -3.33%). The Midwest, South, and West also experienced steep declines from 2007 to 2010/2011 (APC: -25.59%, -20.66%, and -26.75%, respectively). Conclusion: CAD-related mortality in IBD patients has declined over the past 2 decades, with the steepest drops between 2007 and 2011 across most groups. However, disparities remain. Black individuals, males, and those in less urban areas saw fewer minor or inconsistent improvements. These trends point to ongoing gaps in care and highlight the need for more focused efforts to ensure equitable cardiovascular outcomes for people living with IBD. This decline is assumed to be due to the use of effective immunosuppressive and biologic therapies in IBD patients, which leads to better control of systemic inflammation, the driver of atherosclerosis. Additionally, advances in the management and prevention of CAD, as well as increased awareness about the disease in this population, have led to more aggressive management of risk factors.