Key takeaways:
- During the pandemic, the white-Black mortality gap widened from 0.27 to 0.41.
- North Carolina had the largest increase in mortality gap by state at + 0.4 per 100,000.
CHICAGO — When comparing inflammatory bowel disease mortality from before the pandemic with during, the gap between related deaths among Black and white patients continued to expand across Southern and Midwestern states, a study found.
The findings were presented at Digestive Disease Week.
Daniyal Raza
“IBD mortality worsened for everyone during COVID — overall age-adjusted mortality rose from 0.93 to 1.17 per 100,000, and both white and Black patients saw their numbers go up. No group was spared,” Daniyal Raza, MD, assistant professor of medicine and hospitalist at LSU Health Shreveport, told Healio.
“What was intriguing was what happened beyond that overall rise,” he added.
Raza and colleagues looked at results from the CDC WONDER Multiple Cause of Death database from 2018 to 2023 to identify deaths with IBD as an underlying or contributing cause.
Using age-adjusted mortality rates per 100,000 population, they looked at results by states and race. Five had 20 or fewer IBD-related deaths and were excluded from analysis, so 45 states were included Of those 45, nine states had complete paired data.
Raza and colleagues divided the study into two time periods, with pre-COVID years defined as 2018 to 2019 and COVID-era years defined as 2020 to 2023.
For both time periods combined, 7,000 deaths were recorded as IBD-related across the U.S. Overall IBD mortality increased from 0.93 to 1.17 per 100,000. Researchers found that white mortality rose from 0.96 to 1.24, while Black mortality rose from 0.57 to 0.41. The white/Black mortality gap widened from 0.27 to 0.41.
At this point, results were intriguing, he said.
“Eight of nine states showed widening white-Black mortality gaps, validating the national finding,” Raza said. “But the magnitude differed dramatically — North Carolina saw the largest increase at + 0.4, California the smallest at + 0.1 — a fourfold difference during the same pandemic.
“North Carolina spent the entire study period without Medicaid expansion, raising a compelling hypothesis about insurance access.”
California, in contrast, had expansion of Medicaid throughout the pandemic time studied. However, states including Illinois and New York also had Medicaid expansion early in the pandemic yet still had moderate widening of the race/geographic gap. Those results show that insurance is likely not the only factor driving health disparities in the IBD population, Raza pointed out.
“North Carolina raises the hypothesis. The other states tell you the answer is more complex than one variable,” Raza said.
The study had another intriguing finding, Raza said. White individuals had a larger absolute rise in mortality, yet the gap between white and Black individuals still widened. “Black patients were already starting from a lower baseline of care access,” Raza said. “A smaller rise on top of an already disadvantaged starting point was enough to keep the gap growing.”
Study limitations included the exclusion of Alaska, Hawaii, Montana, Vermont and Wyoming because they were under the 20-deaths threshold, and that Raza and colleagues could not adjust for factors such as comorbidities, insurance coverage or disease severity, and treatment type.
Next steps for research include examining Medicaid coverage during the pandemic and whether if having it earlier in specific U.S. states meant protection against widening racial mortality gaps in IBD.
“North Carolina is a compelling natural experiment for that question, given it only expanded Medicaid in December 2023, after our study period had already ended,” Raza said. “That next study would let us move from simply describing the problem to identifying concrete, policy-relevant levers that actually make a difference in IBD outcomes.”
For more information:
Daniyal Raza, MD, can be reached at daniyal.raza@lsuhs.edu.
Sources/Disclosures
Source:
Disclosures:
Raza reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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