S2104 Temporal Trends in Clostridioides difficile-Associated Mortality in the United States: A 25-Year Retrospective Analysis (1999-2023)

Introduction: Clostridioides difficile enterocolitis (CDE) is a significant cause of morbidity and mortality, especially in older adults who are at high risk for this infection. However, data allowing insight into its mortality trends is unexplored. Our study looks over the past 25 years (1999-2023) to uncover trends and disparities in CDE mortality. Methods: Mortality data was obtained from CDC WONDER for individuals aged ≥55 years using International Classification of Diseases, Tenth Revision code (A04.7). Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Joinpoint regression analysis was used to estimate annual and average annual percentage change (APC; AAPC), with statistical significance defined as 95% confidence interval [CI] excluding zero (P < 0.05). Results: A total of 206,615 deaths occurred from CDE. AAMR started from 2.57, abruptly rose till 2005 (12.91; APC: 34.2 [95% CI, 25.8 to 38.6]), with a much slower rise occurring till 2011 (16.91), followed by a decline till 2023 (7.38; AAPC: 5.13 [95% CI, 2.83–7.48]). Women had most deaths (58.6%), but men (11.41) had slightly higher AAMR average than women (10.84). Females AAMR rose sharply from 1999 (2.37) till 2005 (12.46) [APC: 34.59], with a much slower rise till 2011 (16.76) and a subsequent decline till 2023 (7.31). Men’s AAMR rose sharply from 1999 (2.91) till 2005 (13.7) [APC: 32.00], followed by a slow rise till 2008 (17.15) and a subsequent fall till 2023 (7.45). Non-Hispanic (NH) Whites had the greatest deaths (84.98%) and AAMR average (11.72), followed by NH Blacks (7.54%) (9.36) and Hispanics (5.17%) (7.86). Individuals aged 75 and over had most deaths (72.59%) and a consistently higher AAMR trend, starting from 7.01 and rising till 2008 (47.00), before declining till 2023 (17.65). AAMR of individuals between 55-74 years, started from 0.82 and went up to 5.23 in 2016, before declining to 3.34 in 2023. Northeast had the highest average AAMR (12.59) and 22.45% deaths, followed by Midwest (12.04) (24.49%), West (10.25) (19.21%) and South (9.99) (32.93%). Urbanization data, limited to 2020, revealed higher deaths (74.78%) and AAMR in metropolitan areas (11.93) vs nonmetropolitan (10.61). From 1999-2020 Rhode Island (25.42) had the highest AAMR, while from 2021 till 2023 Kentucky did (14.5). Conclusion: Despite an initial rise in mortality, a significant downward trend has been seen in the past decade. However, it is not uniformly benefiting all populations, with Hispanics and those aged between 55-74 being less benefited. Men, NH Whites, and those aged 75+ years remain at an overall increased risk.