NATIONWIDE TRENDS AND DISPARITIES IN INFLAMMATORY BOWEL DISEASE-RELATED CANCER MORTALITY IN THE UNITED STATES

Abstract BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal and extraintestinal malignancies due to chronic inflammation, immunosuppressive therapy, and cumulative disease burden. However, long-term national patterns in IBD-related cancer mortality remain poorly defined. METHODS We analyzed mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) for IBD-related cancers from 1999 to 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 using the 2000 US standard population. Analyses were stratified by demographics, geography, and place of death, with temporal trends assessed using Joinpoint regression to estimate annual percent change (APC) with 95% confidence intervals (CI). RESULTS From 1999-2020, there were 12,402 IBD-related cancer deaths (AAMR 0.17). Mortality rates increased with age, peaking among individuals aged 75-84 years (26%) and 65-74 years (25%). Males accounted for 55% of deaths with a higher AAMR than females (0.22 vs. 0.12). Male mortality rose steadily until 2018, then accelerated sharply (APC, +15.1% from 2018 to 2020, p < 0.001). Female mortality remained largely stable until 2017, followed by a significant increase (APC +10.9% from 2017 to 2020, p = 0.005). By race, White patients comprised 93% of deaths (AAMR 0.18), compared with Black (6%, AAMR 0.10), Asian/Pacific Islander (0.8%, AAMR 0.03), and American Indian/Alaska Native (0.2%, AAMR 0.05). Only 2.4% of deaths occurred among Hispanic patients (AAMR 0.04). State-level variation was observed, with the highest crude rates in North Dakota and Nebraska (0.41), and the lowest in Nevada and Louisiana (0.08). Mortality rates were higher in smaller metropolitan and nonmetropolitan areas (AAMR 0.19, accounting for 22% of total deaths) compared with large urban areas (48% of total deaths). Place of death differed, with 38% occurring at home, 32% in inpatient facilities, 14% in nursing/long-term care, and 9% in hospice. Temporal analysis revealed a shift after 2009. Overall mortality was stable from 1999-2009 (APC -0.8%, p = 0.38) but increased significantly from 2009-2020 (APC +3.2%, 95% CI 1.9-9.4, p < 0.01). CONCLUSIONS The rise in IBD-related cancer deaths in recent years is a concerning trend. Older individuals, as well as residents of smaller areas, are noted to be disproportionately affected, and a higher percentage of these deaths are occurring outside of medical facilities, suggesting potential gaps in supportive and palliative care. These findings emphasize the need for enhanced and continued cancer surveillance and prevention in the geriatric population, as well as equity-based interventions within the IBD population.