Increased gastrointestinal bleeding-related mortality during the COVID-19 pandemic

Xu Gao; Yee Hui Yeo; Fan Lv; Xinyuan He; Justin Park; Jamil Samaan; Yunyu Zhao; Wee Han Ng; Jinhai Wang; Fanpu Ji; Gil Y Melmed

doi:10.1177/17562848241311006

Increased gastrointestinal bleeding-related mortality during the COVID-19 pandemic

Therap Adv Gastroenterol. 2025 Jan 2:18:17562848241311006. doi: 10.1177/17562848241311006. eCollection 2025.

Authors

Xu Gao¹, Yee Hui Yeo², Fan Lv³, Xinyuan He⁴, Justin Park⁵, Jamil Samaan³, Yunyu Zhao⁴, Wee Han Ng⁶, Jinhai Wang¹, Fanpu Ji⁷, Gil Y Melmed⁸

Affiliations

¹ Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
² Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³ School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China.
⁴ Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁵ Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁶ Bristol Medical School, University of Bristol, Bristol, UK.
⁷ Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xi Wu Road, Xi'an 710004, Shaanxi Province, China National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, China Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, China Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, China.
⁸ F. Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, West Hollywood 90048, CA, USAKarsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Abstract

Background: Despite its significant health burden, there is a lack of national-level temporal patterns in gastrointestinal bleeding (GIB) mortality.

Objectives: To comprehensively decipher the annual and monthly trend of GIB-related mortality in the United States.

Design: Cross-sectional study.

Methods: We analyzed the National Vital Statistic System database, which documents more than 99% of the annual deaths in the United States for GIB-related deaths from January 2010 to May 2023. Annual and monthly age-standardized mortality rates were estimated and categorized by age, sex, and bleeding site. Joinpoint regression was performed for trend analysis. Prediction modeling was conducted to determine the GIB-associated excess mortality.

Results: A total of 529,094 and 210,641 GIB-associated deaths occurred before and after 2020, respectively. Following a stably decreasing trend between 2010 and 2019, there was an excess mortality rate during the pandemic which peaked in 2021. The monthly mortality trend showed spikes corresponding to the outbreak of variants. Importantly, excess GIB-related mortality resolved in 2023, with the convergence of predicted and observed mortality rates. Subgroup analysis showed that young males (aged 19-44 years) were affected the most during the pandemic, with excess mortality rates of 35.80%, 52.77%, and 31.46% in 2020, 2021, and 2022, respectively. While the increasing trend of upper GIB was accentuated during the pandemic, lower GIB showed a reversal of the pre-pandemic decreasing trend.

Conclusion: Our findings demonstrate the trend of GIB-related mortality, underscoring an increased excess death during the pandemic followed by a resolution in 2023. We identify subpopulations vulnerable to the pandemic.

Keywords: COVID-19 outbreak impact; age-standardized mortality rates; annual percentage change; gastrointestinal hemorrhage trends; public health.

Plain language summary

Increased gastrointestinal bleeding-related mortality during the COVID-19 pandemic Why was the study done? While the COVID-19 pandemic has incurred substantial gastrointestinal (GI)-related excess mortality, the detailed temporal trends throughout the pandemic’s duration remain unclear. What did the researchers do? Using a nationwide mortality database, we identified deaths related to GI bleeding that occurred between January 2010 and May 2023. What did the researchers find? A total of 529,094 and 210,641 GI bleeding-associated deaths occurred before and during the pandemic, respectively. The annual excess mortality rate peaked in 2021 and declined in 2022. The monthly mortality trend showed spikes corresponding to the outbreak of new variants. Importantly, excess GI bleeding-related mortality resolved in 2023, with the convergence of predicted and observed mortality rates. Subgroup analysis showed that young males (aged 19-44 years) were affected the most during the pandemic, with excess mortality rates of 35.80%, 52.77%, and 31.46% in 2020, 2021, and 2022, respectively. While the increasing trend of upper GI bleeding was accentuated during the pandemic, lower GI bleeding showed a reversal of the pre-pandemic decreasing trend. What do the findings mean? Our findings demonstrate the resolution of excess GI bleeding-related mortality in 2023 and identify subpopulations vulnerable to the pandemic. It has implications for policymakers in addressing the current pandemic and preparing for future pandemics.