S745 Where Adults With Malnutrition Die: A Nationwide Analysis of Mortality Settings Using CDC WONDER, 1999–2022

Introduction: Malnutrition, characterized by over- or undernutrition, remains a serious concern in the United States, affecting more than 30% of its patients. We assessed trends in malnutrition‐related mortality in the U.S. from 1999 to 2022 among adults (≥ 25 years old) to determine differences by age, sex, ethnoracial groups, urbanization, and census region. Methods: This study analyzed death certificates from the CDC WONDER database, focusing on mortality caused by malnutrition in adults (≥25 years old) from 1999 to 2022. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) with 95% confidence intervals (CIs) were computed and categorized by year, age, gender, race, census region, state, and metropolitan status using joinpoint regression analysis. Results: A total of 755,857 deaths were reported in patients with malnutrition. AAMR increased from 11.9 to 24.7 per 100,000 population between 1999 and 2022. The mortality trend declined from 1999 to 2006 (APC = –5.94; 95% CI: –7.98, –4.68; P < 0.000001), plateaued till 2013, then began to rise from 2013 to 2022 with an APC of 14.44 (95% CI: 13.81, 15.3; P < 0.000001) and an overall AAPC of 3.31 (95% CI: 3.08, 3.55; P < 0.000001). Persons 55-74 years of age (AAPC = 3.51; 95% CI: 3.35, 3.73; P < 0.000001), women (AAPC = 3.53; 95% CI: 3.27, 3.78; P < 0.000001), Non-Hispanic Whites (AAPC = 3.67; 95% CI: 3.43, 3.90; P < 0.000001), residents of U.S. Western region (AAPC = 4.01; 95% CI: 3.70, 4.35; P < 0.000001), and medium metropolitan areas (AAPC = 2.98; 95% CI: 2.75, 3.26; P < 0.000001) had the highest AAPCs in their respective groups. Conclusion: Reversing the earlier declining trends, malnutrition-related mortality has increased significantly over the past decade in the U.S. Disparities were evident, with the most pronounced increases seen in 55–74-year-olds, women, Non-Hispanic Whites, and residents of the Western U.S. and medium metropolitan areas. Targeted public health interventions and nutritional programs, ensuring food security and early detection are necessary to address and reduce the rising rates of malnutrition-related mortality among adults in light of these disparities.