Rising mortality from electrolyte and acid-base imbalances in the United States (1999-2020): a joinpoint regression analysis of national trends and disparities.

BACKGROUND

Electrolyte and acid-base imbalance (EABI) has emerged as a critical contributor to rising mortality rates worldwide. However, there is an inconsistency in the data on long-term mortality trends associated with EABI in the United States.

OBJECTIVES

This study aims to evaluate nationwide mortality trends associated with EABI from 1999 to 2020.

METHODS

We utilized the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database to retrieve EABI-associated mortality data among U.S. populations. We analyzed EABI-related deaths (ICD-10 codes E87.0-E87.8) across all ages, with subgroup analyses by EABI subcategory and common underlying causes: heart failure (I50), diabetes mellitus (E10-E14), sepsis (A41), and chronic kidney disease (N18). Age-adjusted mortality rates (AAMRs) were calculated per 100 000 persons, and annual percent changes (APCs) in mortality trends were determined using the joinpoint regression model with corresponding 95% confidence intervals. AAMRs were further stratified by race, sex, age, U.S. census region, and urbanization status.

RESULTS

Between 1999 and 2020, a total of 580 238 deaths occurred due to EABI. Overall, the AAMRs increased from 7.88 to 12.25 (AAPC: + 2.1533%; 95% CI: 0.87-3.43; P = 0.000817). Males exhibited consistently higher overall AAMRs as compared to females (8.58 vs 7.29). Among racial groups, Non-Hispanic Blacks had the highest AAMR (12.70), while Asians had the lowest (5.45). Regionally, the South reported the highest AAMR (8.70), followed by the Midwest (7.78), Northeast (7.35), and West (7.06). Non-metropolitan areas had notably higher AAMRs (9.73) than metropolitan counterparts (7.49). Subgroup analysis showed the highest AAMR for acidosis (2.88) and sepsis had the highest by cause (0.30).

CONCLUSION

There is a prominent increase in EABI-linked mortality from 1999 to 2020, with significant disparities in various population groups. These findings warrant the instantaneous implementation of targeted interventions, such as improvement in electrolyte monitoring protocols and expanded access to specialist care, to control the rising burden.