Diseases affecting the digestive system, including the upper gastrointestinal (GI) tract, chronic liver disease, cirrhosis, inflammatory bowel disease and others, are significant causes of death worldwide. Mayo Clinic and North Dakota State University researchers recently delved into demographic data at the national, state and county level in the U.S. to see which populations are most affected by digestive diseases mortality.

They found a significant upward trend in these deaths among Native populations whose race and ethnicity are designated as "American Indian and Alaska Native" in research, in several regions.

"Our findings revealed that Native people experienced the highest mortality rates from diseases affecting the digestive system, particularly among females, which highlights a critical health disparity. This suggests that we need to address regional health inequalities through health care access and disease prevention programs," says Mayo Clinic Advanced Motility Fellow Wafa Aldhaleei, M.D., M.P.H., first author of the study, which was published in the journal Clinical Gastroenterology and Hepatology.

Her research team examined health data from 3,110 U.S. counties and identified 10 counties with the highest prevalence of digestive disease mortality. The 10 counties were Minnehaha County, South Dakota; Cascade County, Montana; Bannock County, Idaho; Gila County, Arizona; Fremont County, Wyoming; La Paz County/Yuma County, Arizona; Oglala Lakota County, South Dakota; Rio Arriba County, New Mexico; Hennepin County, Minnesota; and Woodbury County, Iowa.

They also specifically investigated the digestive diseases mortality rate by race and ethnicity — white, Black, Latino, American Indian and Alaska Native and Asian and Pacific Islander populations — as well as by sex.

Within the 10 counties with the highest digestive disease mortality rate, American Indian and Alaska Native people were affected the most.

Native populations can face barriers such as access to gastrointestinal specialty care and preventive vaccine programs, write the researchers.

"Deep-rooted, systemic racism can affect the design of health policies for certain areas and populations, and that affects health," Dr. Aldhaleei says. "Throughout the world, poverty, food insecurity, lack of access to clean water, environmental exposures, vaccine hesitancy, lack of insurance and health care access, as well as personal risk factors such as excess body weight, alcohol and substance use disorders can influence the gut microbiome."

The researchers conducted statistical analyses on data spanning 2000-2019 from the Global Burden of Disease study. This study encompassed 10 non-cancerous digestive disease categories: cirrhosis and other chronic liver diseases; gallbladder and biliary diseases; pancreatitis; upper digestive system diseases; paralytic ileus and intestinal obstruction; inguinal, femoral and abdominal hernia; inflammatory bowel disease; vascular intestinal disorders; appendicitis and other digestive diseases. The results from this first detailed examination of digestive diseases mortality across race, ethnicity, geography and sex were striking.

"Although the overall national digestive diseases mortality rate has declined, when we look closer, we can see that Native people, as well as white women, had an increased risk of mortality from digestive diseases," Dr. Aldhaleei says. All other races and ethnicities saw fewer deaths from these diseases across the study period.

Additionally, among the states, West Virginia had the highest mortality rate from GI disease in 2019 in the nation.

"This research has the potential to inform public health strategies and policy development to reduce these disparities, particularly among Native populations, and to promote health equity across the U.S.," says lead and corresponding author Akshaya Bhagavathula, Ph.D., who is a research collaborator at Mayo Clinic in Florida.

The researchers advocate for targeted interventions to reduce the health disparities revealed by their analyses. They support future research to explore the complex interplay of factors contributing to these disparities, including socioeconomic status, cultural barriers and health care access. According to the researchers, developing sustainable solutions will require collaboration between researchers, health care providers, policymakers and community organizations that promote equitable digestive health outcomes and gastrointestinal health equity for all populations.

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