S782 Geographic and Demographic Disparities in Obesity-Related Mortality for Acute Abdominal Emergencies: A US Perspective (1999-2020)

Introduction: Obesity is increasingly recognized as a contributing factor in deaths from acute abdominal conditions such as obstruction, ischemia, and perforation. While these emergencies carry high mortality, national data on the role of obesity in such deaths remain limited. Prior studies focus on surgical cohorts, overlooking broader population trends. This study analyzes U.S. mortality records to assess temporal and demographic patterns in deaths where both obesity and acute abdominal emergencies were listed as contributing causes. Methods: Mortality data were extracted from the CDC WONDER database (1999-2020), identifying deaths using International Classification of Diseases, Tenth Revision (ICD-10) codes for obesity (E66) and acute abdominal emergencies, including perforations, obstruction, acute ischemia, complicated diverticular disease, and ruptured abdominal aortic aneurysm. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated using the 2000 U.S. standard population. Joinpoint regression evaluated annual percent changes (APCs), with statistical significance defined as a 95% confidence interval (CI) excluding zero (P < 0.05). Following STROBE guidelines, demographic and geographic factors were analyzed for patients aged ≥18 years, accounting for the growing burden of obesity among younger adults. Results: Between 1999 and 2020, 14,830 deaths were recorded (AAMR: 2.16), with a significant overall rise in mortality (APC = 3.42, CI: 2.66-4.19). Women had a higher AAMR (2.28) compared to men (1.99), both genders showing a significant gradual rise in mortality till 2018 (APC = 1.95 vs 3.49), followed by a significant sharp increase 2018 onwards (APC = 18.51, CI: 3.06-36.28 vs 20.90, CI: 6.16-37.70). Racial disparities were marked, American Indian/Alaska Natives had the highest AAMR (3.97), followed by non-Hispanic (NH) Blacks (2.75), NH Whites (2.19), and Hispanics (1.83); Asian/Pacific Islanders had the lowest (0.38) Regionally, the West reported the highest AAMR (2.58), while the Northeast had the lowest (1.76). At the state level, Vermont had the highest rate (5.94) and Virginia the lowest (1.03). Mortality was also higher in non-metro micropolitan areas (2.84) compared to large fringe metropolitan areas (1.67). Conclusion: The sharp recent rise in obesity-related mortality from acute abdominal emergencies, especially among rural and Indigenous populations, highlights the need for targeted health policy reforms addressing surgical access, perioperative care, and social determinants of health.