Malignancy as a rising contributor to mortality in patients with inflammatory bowel disease: a population-based epidemiological study.

Abstract

Background: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with increased malignancy risk. This study assessed national trends in malignancy-related mortality among United States IBD patients from 1999 to 2020 using representative data.

Methods: A retrospective, population-based analysis was conducted using the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database. Deaths among individuals with IBD were identified using ICD-10 codes K50 and K51, while malignancy-related deaths were captured using codes C00-C97. Crude and Age-adjusted mortality rates (AMRs) were calculated and stratified by sex, ethnicity, region, state, and age group. Linear regression models evaluated trends and forecast malignancy-related mortality through 2030.

Results: Between 1999 and 2020, 9,531 malignancy-related deaths occurred among IBD patients. Malignancy-related deaths rose significantly, increasing by 108.3% (p = 0.010, R² = 0.439). Higher AMRs were observed among males (p = 0.009), White individuals (p = 0.019), Midwest residents (p = 0.015), and patients aged ≥ 65. The largest relative increases were among females (55.2%), White individuals (55.1%), West residents (75.2%), and those aged 65-74 years (72.6%). Lung and colon cancers were the leading causes of malignancy-related deaths. Projections suggest continued rises in malignancy-related AMRs, particularly among CD patients, while UC patients remain relatively stable.

Conclusion: Malignancy is an increasingly important contributor to mortality among US IBD patients, particularly older adults, males, Midwest residents and White individuals. These findings highlight the need for enhanced cancer surveillance, equitable healthcare access, and integrated long-term management of IBD populations.