SEPSIS AND CLOSTRIDIOIDES DIFFICILE IN U.S. DEATHS INVOLVING INFLAMMATORY BOWEL DISEASE: A 21-YEAR NATIONAL ANALYSIS

Abstract BACKGROUND Infections are significant contributors to morbidity in inflammatory bowel disease (IBD), but their impact on mortality at the population level is poorly described. We examined national trends in sepsis and Clostridioides difficile (CDI) among U.S. deaths involving IBD, while examining demographic and geographic variations. METHODS We analyzed data from the CDC WONDER Multiple Cause of Death database, covering 1999 to 2020. Subjects were included if IBD was listed as a contributing cause of death. Sepsis and CDI were identified when listed alongside IBD. Annual proportions and pooled analyses were calculated and stratified by race, sex, and the 2013 National Center for Health Statistics urbanization classification. RESULTS Between 1999 and 2020, 62,780 U.S. deaths listed IBD. Sepsis was listed in 10,029 cases (16.0%), with a decline from 17.4% in 1999 to 14.2% in 2020. CDI was seen in 995 deaths (1.6%). CDI was not reported in the CDC database before 2002, likely due to suppression of small counts, but rose to 2.8% in 2009, and stabilized at 1 to 2% in following years. Subgroup analysis showed that Black populations had higher proportions of sepsis (21%) compared with White populations (16%), while CDI rates were similar (1.4 to 1.6%). Females had slightly higher rates of sepsis (16.7% vs 15.1%) and CDI (1.8% vs 1.4%) compared to males. Differences between rural and urban areas were modest, with sepsis most prevalent in large central metropolitan areas (17.4%) and least in rural counties (14.7%). CONCLUSIONS Sepsis accounts for a substantial share of IBD-related deaths, and CDI has become a modest, persistent factor in recent years. While limited by the use of death certificate data, these results highlight the ongoing role of infection in mortality outcomes for patients with IBD.