Excess non-COVID-19-related mortality among inflammatory bowel disease decedents during the COVID-19 pandemic

Table 1 Demographics of inflammatory bowel disease decedents from 2006-2021, n (%)

	Overall deaths (2006-2021)		Pre-pandemic deaths (2006-2019)		Pandemic deaths (2020-2021)
	Ulcerative colitis	Crohn’s disease	Ulcerative colitis	Crohn’s disease	Ulcerative colitis	Crohn’s disease
Age (yr)
≥ 65	15136 (77.45)	19278 (63.75)	12304 (77.01)	15706 (62.90)	2832 (79.39)	3572 (67.78)
25-64	4408 (22.55)	10960 (36.25)	3673 (22.99)	9262 (37.10)	735 (20.61)	1698 (32.22)
Gender
Male	9805 (50.17)	13317 (44.04)	8087 (50.62)	10951 (43.86)	1718 (48.16)	2366 (44.90)
Female	9739 (49.83)	16921 (55.96)	7890 (49.38)	14017 (56.14)	1849 (51.84)	2904 (55.10)
Race/ethnicity (not including 2021)
Hispanic	726 (4.10)	732 (2.66)	651 (4.07)	651 (2.61)	75 (4.37)	81 (3.19)
Non-Hispanic white	15740 (88.96)	24661 (89.66)	14249 (89.18)	22448 (89.91)	1491 (86.89)	2213 (87.23)
Non-Hispanic black	948 (5.36)	1843 (6.70)	841 (5.26)	1627 (6.52)	107 (6.24)	216 (8.51)

Numbers represent the crude number of deaths that occurred for each group in each time period and percent is the percent of overall death for each disease (ulcerative colitis or Crohn’s disease) that occurred in each time period.

Table 2 All-cause and non-coronavirus disease 2019--related age-standardized mortality rates in United States adults with inflammatory bowel disease, ulcerative colitis and Crohn’s disease overall and by age, gender, and race/ethnicity from 2006-2021

		2006	2019	2020				2021
				Observed all-cause	Predicted (95%CI)	Observed non-COVID	Increase (%)1	Observed all-cause	Predicted (95%CI)	Observed non-COVID	Increase (%)1
	IBD	1.35	1.47	1.68	1.37 (1.26-1.49)	1.55	13.14	1.81	1.38 (1.26-1.49)	1.63	18.12
	UC	0.51	0.59	0.68	0.55 (0.49-0.60)	0.61	10.91	0.73	0.55 (0.50-0.60)	0.65	18.18
	CD	0.84	0.89	1.01	0.91 (0.81-1.02)	0.95	4.40	1.09	0.97 (0.82-1.12)	0.99	2.06
Age
25-64 yr	IBD	0.53	0.59	0.68	0.61 (0.55-0.66)	0.65	6.56	0.71	0.64 (0.57-0.72)	0.64	0.00
	UC	0.14	0.19	0.21	0.17 (0.15-0.19)	0.20	17.65	0.21	0.17 (0.15-0.19)	0.18	5.88
	CD	0.39	0.41	0.47	0.42 (0.37-0.47)	0.46	9.52	0.50	0.45 (0.38-0.52)	0.46	2.22
≥ 65 yr	IBD	4.69	5.03	5.76	4.95 (4.49-5.40)	5.23	5.66	6.28	5.07 (4.54-5.60)	5.67	11.83
	UC	2.02	2.21	2.59	2.3 (2.01-2.58)	2.31	0.43	2.81	2.45 (2.04-2.86)	2.53	3.27
	CD	2.67	2.83	3.20	2.79 (2.46-3.12)	2.95	5.73	3.48	2.87 (2.49-3.25)	3.15	9.76
Sex
Female	IBD	1.28	1.38	1.61	1.42 (1.24-1.61)	1.48	4.23	1.76	1.51 (1.25-1.78)	1.59	5.30
	UC	0.43	0.50	0.60	0.53 (0.44-0.61)	0.54	1.89	0.68	0.57 (0.44-0.70)	0.60	5.26
	CD	0.85	0.88	1.02	0.9 (0.78-1.02)	0.95	5.56	1.09	0.94 (0.76-1.12)	0.99	5.32
Male	IBD	1.44	1.58	1.76	1.63 (1.49-1.76)	1.63	0.00	1.87	1.73 (1.54-1.92)	1.68	-2.89
	UC	0.62	0.70	0.76	0.68 (0.62-0.75)	0.70	2.94	0.78	0.7 (0.63-0.78)	0.69	-1.43
	CD	0.83	0.89	1.00	0.93 (0.83-1.04)	0.94	1.08	1.10	1.01 (0.86-1.16)	0.99	-1.98
Race/ethnicity
Non-Hispanic white	UC	0.57	0.68	0.79	0.71 (0.63-0.78)	0.71	0.00	N/A	N/A	N/A	N/A
	CD	0.96	1.08	1.22	1.12 (0.99-1.25)	1.15	2.68	N/A	N/A	N/A	N/A
Non-Hispanic black	UC	0.24	0.36	0.42	0.41 (0.29-0.52)	0.39	-4.88	N/A	N/A	N/A	N/A
	CD	0.57	0.58	0.81	0.55 (0.41-0.70)	0.75	36.36	N/A	N/A	N/A	N/A
Hispanic	UC	0.36	0.23	0.30	0.23 (0.07-0.38)	0.26	13.04	N/A	N/A	N/A	N/A
	CD	0.22	0.24	0.30	0.27 (0.08-0.47)	0.27	0.00	N/A	N/A	N/A	N/A

¹Increase (%) represents the percent of increase from predicted to observed non-coronavirus disease 2019-related age-standardized mortality rate.

Age-standardized mortality rate (per 100000 persons). All-cause represents coronavirus disease 2019 (COVID-19)-related and non-COVID-19-related. IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CD: Crohn’s disease; COVID-19: Coronavirus disease 2019; CI: Confidence interval; N/A: Not applicable.

Table 3 All-cause and non-coronavirus disease 2019-related age-standardized mortality rates in United States adults with inflammatory bowel disease by death place, 2006-2021

	2006	2019	2020				2021
			Observed all-cause	Predicted (95%CI)	Observed non-COVID	Increase (%)1	Observed all-cause	Predicted (95%CI)	Observed non-COVID	Increase (%)1
Home or on arrival	0.32	0.47	0.62	0.46 (0.42-0.49)	0.61	32.61	0.63	0.47 (0.43-0.51)	0.61	29.79
Medical facility	0.73	0.56	0.60	0.49 (0.41-0.57)	0.52	6.12	0.73	0.48 (0.39-0.56)	0.59	22.92
Nursing home	0.23	0.24	0.24	0.24 (0.20-0.27)	0.21	-12.50	0.24	0.24 (0.20-0.28)	0.22	-8.33
Hospice facility	0.03	0.15	0.15	0.16 (0.14-0.17)	0.15	-6.25	0.14	0.17 (0.15-0.18)	0.13	-23.53

¹Increase (%) represents the percent of increase from predicted to observed non-coronavirus disease 2019-related age-standardized mortality rate.

Age-standardized mortality rate (per 100000 persons). All-cause represents coronavirus disease 2019 (COVID-19)-related and non-COVID-19-related. COVID-19: Coronavirus disease 2019; CI: Confidence interval.