Health Care Quality and Delivery
Sidra Naz, MD (she/her/hers)
Postdoctoral Fellow
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Background: Patients with ulcerative colitis (UC) are six times more likely to develop colorectal cancer (CRC). However, there is no consensus on population-level data regarding the impact of colorectal cancer on mortality in individuals with ulcerative colitis. Methods: Mortality trends in UC adults with CRC aged ≥25 years were analyzed using the CDC WONDER database, identifying through ICD-10 codes K51 “Ulcerative Colitis” and C18.9 “Colorectal Malignant neoplasms”. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs, with 95% confidence intervals, were determined using joint point regression analysis across various demographic (sex, race/ethnicity, age) and geographic (state, urban-rural, regional) subgroups.
Results: Between 1999 and 2020, 1103962 documented deaths were attributed to UC associated with CRC. The overall AAMR for UC and CRC-related mortality decreased in the US from an adjusted rate (AR) 31.9 in 1999 to (30.8) in 2001 (APC:-1.48%; 95% CI: -2.95% to -0.09%), then it decreased further to 21.9 in 2011 (APC: -3.47%; 95% CI: -4.48% to -3.30%) and to 17.2 in 2020(APC: -2.78%; 95% CI: -3.12% to -1.54%). In Texas, AAMR for UC and CRC decreased from AR 30.8 in 1999 to 19.8 in 2014 (APC: -2.78%; 95% CI: -3.85% to -2.56%), after which it decreased to 17.9 in 2020 (APC: -1.76%; 95% CI: -2.48% to 0.29%). Males had consistently higher AMMR than females (20.6 vs 14.5). The AAMR in U.S. men decreased from 39.3 in 1999 to 20.6 in 2020 (APC: -1.14%; 95% CI: -3.10% to -0.09%). The AAMR in U.S. women decreased from 27 in 1999 to 14.5 in 2020 (APC: -3.15%; 95%CI: -3.29% to -3.02%). The non-Hispanic (NH) Black or African American (AA) population has the greatest AAMR (23.1), followed by the NH American Indian or Alaska Native with AAMR (18.2) and the NH White (17.1). The lower-risk population was the Hispanic or Latino population with AAMR (14) and NH Asian or Pacific Islanders with AAMR (11.4). AAMR also varied by region (South: 18.2; Midwest: 18; Northeast: 16.2; West: 15.9), and non-metropolitan areas had higher AAMR (small metro: 17.5; micropolitan: 20.1; non-core areas: 21.5) than metropolitan areas (large central metropolitan: 16.4; large fringe areas: 16.2). The states in the upper 90th percentile of AAMRs were Wyoming, Nebraska, Oklahoma, Arkansas, Louisiana, Mississippi, Kentucky, West Virginia exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile i.e Oregon, Washington, Montana, Utah, Wisconsin, North Carolina.
Conclusion: Mortality rates from ulcerative colitis and colorectal cancer have declined in the United States and Texas over the past two decades. However, significant demographic and geographic disparities continue, emphasizing the need for further investigation the development of targeted treatment strategies.