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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Excess non-COVID-19-related mortality among inflammatory bowel disease decedents during the COVID-19 pandemic
Sarah Rotondo-Trivette, Xin-Yuan He, Jamil S Samaan, Fan Lv, Emily Truong, Michaela Juels, Anthony Nguyen, Xu Gao, Jian Zu, Yee Hui Yeo, Fan-Pu Ji, Gil Y Melmed
Sarah Rotondo-Trivette, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Xin-Yuan He, Xu Gao, Fan-Pu Ji, Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Jamil S Samaan, Emily Truong, Yee Hui Yeo, Karsh Division of Gastroenterology and Hepatology Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Fan Lv, Jian Zu, School of Mathematics and Statistics, Xi’an Jiaotong University, Xi’an 710049, Shaanxi Province, China
Michaela Juels, Anthony Nguyen, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, United States
Xu Gao, Division of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Fan-Pu Ji, National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Fan-Pu Ji, Key Laboratory of Surgical Critical Care and Life Support (Xi’an Jiaotong University), Ministry of Education, Xi’an 710004, Shaanxi Province, China
Gil Y Melmed, Karsh Division of Gastroenterology and HepatologyDepartment of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Co-first authors: Sarah Rotondo-Trivette and Xin-Yuan He.
Co-corresponding authors: Fan-Pu Ji and Gil Y Melmed.
Author contributions: Rotondo-Trivette S and Samaan JS contributed to conceptualization; Rotondo-Trivette S and He XY were involved in the methodology; Rotondo-Trivette S contributed to the visualization; Rotondo-Trivette S, He XY, Truong E, Juels M, and Nguyen A wrote original draft; Rotondo-Trivette S, Samaan JS, Lv F, Truong E, Juels M, Nguyen A, Gao X, Zu J, Yeo YH, Ji FP, and Melmed GY participated in the review and editing; He XY, Lv F, and Zu J contributed to the data curation; He XY, Lv F, Gao X, and Zu J were involved in the formal analysis; Rotondo-Trivette S, Samaan JS, Ji FP, and Melmed GY contributed to the project administration; He XY and Yeo YH were involved in the validation; Yeo YH contributed to conceptualization; Yeo YH, Ji FP, and Melmed GY participated in the supervision. Rotondo-Trivette S and He XY contributed equally to this study. Ji FP and Melmed GY co-designed and co-supervised conduct research, and contributed equally to this study.
Institutional review board statement: Since all data from National Vital Statistics System were publicly available and completely de-identified, the study is deemed exempt from the Institutional Review Board statement.
Informed consent statement: Since all data from National Vital Statistics System were publicly available and completely de-identified, obtaining informed consent statement was not available in this study.
Conflict-of-interest statement: Melmed GY discloses position as consultant/advisor to: Abbvie, Arena Pharmaceuticals, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Genentech, Gilead, Ferring, Fresenius Kabi, Janssen, Oshi, Pfizer, Prometheus Labs, Samsung Bioepis, Takeda, Techlab. Ji FP discloses position as consultant/advisor to: Gilead Sciences, MSD, and speaker to: Gilead Sciences, MSD and Ascletis. All other authors have no conflicts of interest to disclose.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Gil Y Melmed, MD, MSc, Professor of Medicine, Director, Infla-mmatory Bowel Disease Clinical Research; Associate Director, Karsh Division of Gastro-enterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, 8730 Alden Drive, Thalians Building, 2nd Floor East, Los Angeles, CA 90048, United States. gil.melmed@cshs.org
Received: November 20, 2023
Revised: January 10, 2024
Accepted: February 22, 2024
Published online: May 28, 2024
Processing time: 188 Days and 20.4 Hours
ARTICLE HIGHLIGHTS
Research background
Prior studies have shown that inflammatory bowel disease (IBD)-related mortality increased dramatically during the coronavirus disease 2019 (COVID-19) pandemic.
Research motivation
We aim to investigate the difference in excess mortality between COVID-19-related and non-COVID-19-related deaths in IBD-related decedents during the pandemic. We further explore disparities among subgroups within ulcerative colitis (UC) and Crohn’s disease (CD).
Research objectives
Utilizing Vital Statistics Online Data Portal of the National Vital Statistic System from January 1, 2006 through December 31, 2021, we focused on IBD-related decedents aged 25 years or older. We performed subgroup analyses including age, sex, race/ethnicity, place of death, and primary cause of death.
Research methods
We used the direct model to calculate age-standardized mortality rates (ASMRs), with the 2010 United States Census Standard Population as the reference. Time series regression models predicted mortality rates in 2020 and 2021 based on trends from 2006 to 2019, estimating the pandemic’s impact on IBD-related mortality. The excess death was categorized into COVID-19-related and non-COVID-19-related.
Research results
A total of 49782 IBD-related deaths were documented during the study period. Non-COVID-19-related mortality among IBD decedents increased by 13.14% in 2020 and 18.12% in 2021. Notably, young UC patients and non-Hispanic black (NHB) CD patients increased at an unprecedented rate, 17.65% and 36.36%, respectively. Non-COVID-19-related deaths at home or on arrival at the hospital exhibited the most substantial upward trend during the pandemic, reaching 32.61% in 2020 and 29.79% in 2021.
Research conclusions
Non-COVID-19-related ASMR for IBD-related deaths increased at alarming rates during the COVID-19 pandemic in the United States, particularly in younger age UC patients, and NHB CD patients.
Research perspectives
Our findings have vital implications for public health strategies, emphasizing the need for enhanced surveillance of IBD patients. The research underscores the importance of placing greater attention on young UC and NHB CD patients during future healthcare crises. .
