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Background Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality in hospitalized patients with inflammatory bowel disease (IBD). While racial disparities in VTE outcomes have been documented in other conditions, limited data exist for IBD. We examined racial disparities in VTE among hospitalized IBD patients and temporal trends from 2019-2022.Methods We conducted a retrospective cohort study using the National Inpatient Sample (2019-2022). Adult patients with IBD were identified using ICD-10-CM codes. The primary outcome was in-hospital VTE (deep vein thrombosis or pulmonary embolism). Multivariable logistic regression with cluster-robust standard errors examined the association between race and VTE, adjusting for demographics, comorbidities, IBD type, procedures, and hospital characteristics.Results Among 1,133,260 weighted IBD hospitalizations, the overall VTE rate was 3.34%. Black patients experienced higher crude VTE rates compared to White patients (3.81% vs 3.37%). After full adjustment, Black patients had 32% higher odds of VTE compared to White patients (aOR 1.32, 95% CI 1.22-1.43). This disparity persisted across all years but showed a non-significant trend toward narrowing (aOR 1.43 in 2019 vs 1.23 in 2022, p-interaction=0.20). Disparities were largest among Medicare beneficiaries (aOR 1.40) and patients with ulcerative colitis (aOR 1.49), while no significant disparity was observed among Medicaid patients (aOR 1.10, p=0.27) ( IDDF2026-ABS-0237 Figure 1, IDDF2026-ABS-0237 Table 1).Conclusions Significant racial disparities in VTE persist among hospitalized IBD patients, with Black patients experiencing 32% higher adjusted odds of VTE. These disparities are not explained by differences in comorbidities or disease severity, suggesting potential differences in care processes such as thromboprophylaxis delivery. Targeted quality improvement initiatives are needed to achieve equitable VTE prevention in IBD.Abstract IDDF2026-ABS-0237 Figure 1Abstract IDDF2026-ABS-0237 Table 1Association between Black race and VTE: sequential adjustment modelsModelaOR (95% CI)P-valueModel 1: Year only1.17 (1.08-1.26)<0.001Model 2: + Age, sex, insurance1.33 (1.24-1.44)<0.001Model 3: + Comorbidities, IBD type, surgery, GI bleeding1.34 (1.24-1.45)<0.001Model 4: + Hospital characteristics1.32 (1.22-1.43)<0.001Year-Stratified (Fully Adjusted)20191.43 (1.22-1.68)<0.00120201.29 (1.10-1.51)0.00220211.35 (1.17-1.56)<0.00120221.23 (1.06-1.44)0.007Subgroup Analyses (Fully Adjusted)Private insurance1.30 (1.13-1.50)<0.001Medicare1.40 (1.25-1.56)<0.001Medicaid1.10 (0.93-1.31)0.27Crohn’s disease1.22 (1.10-1.35)<0.001Ulcerative colitis1.49 (1.32-1.67)<0.001Sensitivity AnalysisExcluding GI bleeding1.32 (1.22-1.44)<0.001Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; VTE, venous thromboembolism.Reference group: White patients. All models use cluster-robust standard errors clustered at the hospital level.