S256 Mortality Shadows: A Quarter-Century Mortality Analysis of Cholangitis Trends and Disparities in the United States

Introduction: Cholangitis is an infection of the biliary tract, that usually arises as a consequence of biliary obstruction or could be secondary to pathogenic infection of the liver. Despite major advances in the field of diagnostics and treatments, the mortality rates due to cholangitis still remain significant. The aim of this study is to analyze demographic disparities and trends in cholangitis-related deaths in the United States from 1999 to 2023 using data from the CDC WONDER database. Methods: Mortality data relating to cholangitis was extracted from the CDC WONDER database from 1999 to 2023. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 population and analyzed annual percent changes (APCs) with 95% confidence intervals. Temporal trends were estimated using the Joinpoint Regression Program (version 5.1.0). Results: Between 1999 and 2023, a total of 51,700 deaths due to cholangitis were reported in the United States. The overall AAMR was 5.09 per 1,000,000 population, with an average annual percent change (AAPC) of 2.29% (95% CI: 1.91–2.54). The cholangitis related mortality trend consisted of 2 phases i.e. a modest increase from 1999 to 2011 (APC: 0.69%, 95% CI: 0.19–1.20) followed by a more rapid rise from 2011 to 2023 (APC: 3.79%, 95% CI: 3.35–4.23). The mortality rates were high among individuals aged 85 and older (crude rate: 70.5), while the greatest AAPC was seen in the 35–44 age group (9.59%, 95% CI: -14.12 to -4.82). Men had a higher AAMR (6.12) compared to women (4.30), though women showed a higher AAPC (2.76%, 95% CI: 2.24–3.27) than men (1.59%, 95% CI: 1.22–1.96). Among different races, Asians had the highest AAMR (6.92), while Whites had the highest AAPC (2.41%, 95% CI: 2.02–2.80). Regionally, the Western region reported the highest AAMR (6.13), while the Midwest had the greatest AAPC (2.86%, 95% CI: 2.04–3.68). Large central metropolitan areas had the highest urban AAMR (5.30) while the medium metro areas showed the highest AAPC (2.54%, 95% CI: 1.85–3.25). The state of Washington showed the highest AAMR (10.64) during the 2018 to 2023 period. Conclusion: Cholangitis related mortality has shown an increase since 2011, with the highest death incidents among older adults, men, and Asians. However, the most rapid rise occurred among younger adults, women, and Whites, indicating shifting epidemiologic trends that require focused public health attention.