S349 Two Decades of Mortality Trends in Paralytic Ileus and Bowel Obstruction in the US

Introduction: Paralytic ileus and intestinal obstruction are major contributors to gastrointestinal mortality, particularly among older adults. This study evaluated temporal trends and demographic disparities in related mortality among U.S. adults aged ≥45 years between 1999 and 2020. Methods: A retrospective analysis of the CDC WONDER Multiple Cause of Death database was conducted. Adults ≥45 years with paralytic ileus and intestinal obstruction as a contributing or underlying cause of death (International Classification of Diseases, Tenth Revision code: K56.0–K56.7) were included. Age-adjusted mortality rates (AAMRs) and crude death rates (CDRs) per 100,000 persons were calculated using the 2000 U.S. Standard Population. Temporal trends were assessed using Joinpoint regression to estimate average annual percent change (AAPC) with 95% confidence intervals (CI). Results: A total of 346,007 deaths were reported during the study period. The overall AAMR declined from 15.10 in 1999 to 12.75 in 2020 (AAPC: –0.83; P < 0.001), with an average AAMR of 13.4. Males had a slightly higher AAMR than females (13.61 vs 13.23) but experienced a smaller decline in mortality (AAPC: –0.63 vs –1.09; P < 0.001 each). By race, non-Hispanic (NH) Black individuals had the highest AAMR (18.13), followed by NH American Indian/Alaska Native (14.05), NH White (13.50), Hispanic (8.90), and NH Asian/Pacific Islander (6.16). All racial groups showed decreasing trends, with NH Asian/Pacific Islanders showing the steepest decline (AAPC: –1.52; P < 0.001). Regionally, the Midwest reported the highest AAMR (14.46), followed by the South (13.62), with the South demonstrating the largest decline (AAPC: –1.05; P < 0.001). Nonmetropolitan areas had higher mortality than metropolitan areas (15.73 vs 12.90); however, metro areas showed a steeper decline (AAPC: –0.94 vs –0.63; P < 0.001 each). By age group, CDRs declined among adults aged 65–74, 75–84, and ≥85 years, with the greatest decline observed in those aged 75–84 and ≥85 years (AAPC: –1.32 each; P < 0.001). Conversely, CDRs increased among adults aged 45–54 (AAPC: +1.01; P < 0.001) and 55–64 years (AAPC: +0.47; P < 0.001). Conclusion: Mortality from paralytic ileus and intestinal obstruction declined overall between 1999 and 2020 and significant demographic disparities persisted. Elevated mortality remains among elderly males, NH Black individuals, Midwest residents, and those living in nonmetropolitan regions. Notably, rising mortality in middle-aged adults warrants targeted public health intervention.