Geographic disparities and temporal trends in Clostridium difficile Enterocolitis mortality among United States adults from 1999 to 2020 using CDC data

Clostridium difficile infection (CDI) is considered the leading cause of healthcare-associated colitis. This study analyzes CDC data from 1999 to 2020 to assess long-term mortality trends and identify disparities. The findings aim to support public health strategies and enhance healthcare efforts to reduce CDIs-related mortality. We analyzed national mortality data using the CDC WONDER database, including adults aged 25 to 85 + years. Deaths were identified using the ICD-10 Code ICD-10 codes A04.7 (Enterocolitis due to Clostridium Difficile). Age-adjusted mortality rates (AAMR) calculated per 100,000 individuals were abstracted by age groups, sex, race/ethnicity, census region, state and urbanization. Temporal trends were assessed using Joinpoint regression models. Annual percentage changes (APC) in AAMR were estimated using Monte Carlo Permutation and 95% confidence intervals using the Parametric Method. A two-tailed t-test was employed to measure the statistical significance of APCs. From 1999 to 2020, a total of 192,283 deaths were reported associated with C. Diff Infection. Adult CDIs’ mortality (ages > 25) initially increased and then decreased across genders, races, regions, and urbanisation levels. The AAMR showed variability, with an initial increase from 0.87 per 100,000 in 1999 to 4.37 in 2005 (APC = 32.38), followed by a decrease from 2015 to 2020 (APC = -11.74) with a statistically non-significant change in AAMRs between 2005 and 2015. The decline showed fluctuations over time, with significant gender differences (APC for females = 34.75 [from 1999 to 2005], -12.78 [from 2016 to 2020], for males = 32.32 [from 1999 to 2005], -11.12 [from 2015 to 2020]). Among racial groups, Hispanics had the most significant increase in AAMRs (APC = 8.17). The White population showed the most variability, with an initial increase from 1999 to 2005 (APC = 34.16), followed by a decrease from 2016 to 2020 (APC = -12.52). Regionally, the Northeast reported the most significant increase from 2002 to 2005 (APC = 46.76). Urban areas showed a consistent decline from 2016 to 2020 (APC = -12.85), whereas rural areas experienced the most significant increase from 1999 to 2005 (APC = 33.36). Despite national progress, higher mortality rates were observed in Missouri, New Jersey, and Indiana (AAMRs = 7.14–8.55). From 1999 to 2020, CDAC-related mortality in the U.S. was highest in females and Whites, particularly in New Jersey, the medium metro and northeast regions. These disparities highlight the need for targeted public health strategies and further research to promote equitable health outcomes. These findings highlight the need for targeted efforts to reduce Clostridium difficile-associated Enterocolitis mortality, particularly among females, White individuals, and those in the Northeast, and rural areas. Disparities in care and access suggest a need for improved monitoring, early intervention, and region-specific strategies to better manage high-risk populations.