Temporal and demographic trends in infective gastroenteritis-related mortality among U.S. adults: A 25-year nationwide analysis (1999-2023).

BACKGROUND

Infective gastroenteritis remains an important cause of gastrointestinal-related mortality in the United States despite medical advances. Antibiotic resistance, increasing immunosuppression, and population aging may contribute to its burden, yet long-term national mortality trends and disparities are incompletely defined.

METHODS

CDC WONDER multiple cause of death data from 1999-2023 were analyzed for U.S. adults aged ≥25 years. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Joinpoint Regression v5.2.0 estimated annual percent changes (APCs) with 95 % confidence intervals (p ≤ 0.05), stratified by sex, race and ethnicity, region, urbanization, and age group.

RESULTS

From 1999-2023, 304,378 deaths were attributed to infective gastroenteritis. AAMR increased from 1.5 in 1999 to 7.7 in 2010, then declined to 5.0 in 2023. Mortality rose sharply during 1999-2005 (APC=23.4; p < 0.001) and declined thereafter (APC=-4.0; p = 0.008). Males had higher overall mortality compared to females (5.40 and 5.29, respectively), while females showed steeper increases and declines (AAPC for females' and males': 5.92; p < 0.05 and 5.28; p < 0.05, respectively). Non-Hispanic (NH) American Indians had the highest AAMR (6.42), followed by NH Whites (5.62), NH Blacks (4.81), Hispanics (3.93), and NH Asians (2.33). The Northeast showed the highest regional burden (5.89); urban rates slightly exceeded rural rates (5.39 and 5.23, respectively), and adults aged ≥85 years consistently had the highest mortality (23.22). State-wise AAMR ranged between Hawaii to Rhode Island (2.19 to 10.32).

CONCLUSION

Significant demographic and geographic disparities persist, highlighting the need for targeted, equity-focused prevention strategies to reduce preventable deaths across vulnerable populations.