Trends and disparities in peptic ulcer disease-related mortality in the United States from 1999 to 2020: A cross-sectional study

Peptic ulcer disease (PUD) is associated with severe complications such as hemorrhage and perforation, leading to high morbidity and mortality rates despite advancements in treatment. This study aims to evaluate the temporal and regional mortality trends of adults with PUD in the United States from 1999 to 2020, stratified by sex, race/ethnicity, age group, and geographic region. Utilizing death certificate data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database, age-adjusted mortality rates (AAMRs) per 100,000 individuals were derived from crude mortality rates (CMRs). Trends in AAMRs were analyzed through annual percent change (APC) and average APC (AAPC) using Joinpoint regression (Joinpoint Regression Program, V5.0.2). From 1999 to 2020, a total of 37,471 deaths due to PUD were reported in the United States. The AAMR remained stable from 1999 to 2001 (APC: 0.59), followed by a sharp decline from 2001 to 2012 (APC: -11.79). After a period of stability from 2012 to 2018 (APC: 1.53), the trend reversed with an increase from 2018 to 2020 (APC: 8.45). Males had higher AAMR (0.84) than females (0.71). Non-Hispanic Whites had the highest AAMR (0.82), and Hispanics or Latinos the lowest (0.49), with an overall decrease in mortality rates across all racial groups, particularly among Non-Hispanic Black or African Americans. The West had the highest AAMR (0.87), and the Northeast the lowest (0.71), with all regions showing a downward trend. Rural areas exhibited a higher AAMR (0.86) compared to urban areas (0.76). Mortality was most concentrated among adults aged 85 years and older (CMR: 7.63), and the lowest CMR was recorded in the 25 to 54 years age group (0.16). Most deaths occurred in medical facilities (81.89%), followed by decedents' homes (8.36%) and nursing homes/long-term care (3.85%). The District of Columbia (AAMR: 1.47) reported the highest AAMR, while New Jersey (0.59) had the lowest. Despite the overall decline, regional and demographic disparities remain, highlighting the need for continued efforts to address PUD-related mortality.