S883 Mortality Trends and Disparities in Patients With Esophageal Perforation in the United States: A 25-Year CDC WONDER Analysis

Introduction: Esophageal perforation is a rare but life-threatening condition with high morbidity and mortality. This study evaluates 25-year mortality trends in the U.S., focusing on age-adjusted mortality rates (AAMR), sex and regional disparities, and temporal changes. Methods: We utilized the CDC WONDER database to extract age-adjusted mortality data for adults with esophageal perforation (ICD-10: K22.3) from 1999 to 2023. Joinpoint regression analysis was applied to estimate annual percent change (APC) and average annual percent change (AAPC) in mortality trends over time. Results: Between 1999 and 2023, there were 10,951 deaths in the U.S. attributed to esophageal perforation. The AAMR rose from 1.34 to 1.65 per 1,000,000 population, with an AAPC of 0.39. An initial decline in mortality was observed from 1999 to 2005 (APC: -4.39), followed by a stable period (2005-2016), and a significant rise from 2016 to 2023 (APC: 4.95). Among genders, 4,653 deaths occurred in women and 5,862 in men. Female AAMR increased from 0.92 to 1.15 (AAPC: 0.034; 95% confidence interval [CI] -0.93 to 1.15), showing a stable trend, while for men it increased from 1.88 to 2.13 (AAPC: 0.34; 95% CI -0.08 to 0.93). Among women, mortality declined significantly from 1999 to 2008 (APC: -3.58), then began to increase from 2008 to 2023 (APC: 2.27). In men, a steep decline was observed from 2001 to 2004 (APC: -8.89), followed by a prolonged phase of stagnation from 2004 to 2017, and a sharp rise thereafter until 2023 (APC: 5.34). Regionally, the West had the highest rise in AAMR (AAPC: 1.33), driven by a sharp increase from 2013 to 2023 (APC: 5.19). The Northeast followed (AAPC: 0.62), shifting from an initial decline (APC: -1.39) to a sharp rise after 2017 (APC: 6.90). The Midwest saw a modest rise (AAPC: 0.26). The South had the most stable trend (AAPC: 0.13), with a slight decline until 2011 (APC: -2.35) and a mild rise thereafter (APC: 2.67). Rural areas showed an overall AAMR of 1.45 (AAPC: 0.18), while urban areas had a rate of 1.17 (AAPC: -0.21), indicating a higher mortality rate in rural settings. Conclusion: Mortality from esophageal perforation in the U.S. has shown a shifting trend over the past 25 years, with an initial decline followed by stabilization and a notable rise in recent years, particularly after 2016. While overall trends remained largely stable, the increasing mortality among men and in regions like the West and Northeast necessitates targeted strategies for earlier diagnosis and intervention.