S2128 National Trends in Age-Adjusted Mortality Rates of Clostridioides difficile-Related Enteritis, 1999–2020: A CDC WONDER Database Analysis

Introduction: Clostridioides difficile-related enteritis is a leading cause of infectious colitis, often resulting in severe diarrhea and complications such as toxic megacolon or sepsis. The CDC has classified C. difficile as an urgent antibiotic resistance threat due to its rising incidence and severity. Understanding its epidemiologic trends is essential for guiding diagnosis, treatment, and infection control strategies. The mortality due to C. difficile-related enteritis is on the rise in the United States. In this study we explored these trends from 1999-2020, using age adjusted mortality rates (AAMR) to pinpoint incongruities between epidemiological groups. Methods: Our study conducted an in-depth search of the CDC Wonder database, based on the incidence of C. difficile-related enteritis related age-adjusted mortality rate (AAMR) per 100,000 individuals. Employing Join point regression analysis, we assessed parallelism and computed annual percent changes (APC) with a 95% confidence interval. For a P< 0.05, the test of parallelism was considered significant for unparallel. Results: From 1999-2020, a total of 192,723 deaths were reported due to C. difficile-related enteritis. The overall AAMR showed a massive increase from 1999-2005, with an APC of 32.62. Later, the AAMR inclined yet again, but in lesser magnitude from 2005-2008, with an APC of 7.87. The AAMR then showed a decline from 2008-2015, with an APC of -0.85. This was followed by another major decline from 2015-2020, with an APC of -11.52. The highest mortality populations were men and Whites. The geographical hotspots for mortality were large fringe metro and Northeast. The most affected age group was 85+ individuals. Tests for parallelism revealed non-disparate trends across gender (P = 0.079), and urban versus rural demographics (P = 0.14). However, the parallelism test in Northeast versus Midwest (P = 0.0009), and Black versus White (P = 0.01) was significant. The disparity among the demographic variables of C. difficile-related enteritis warrants more investigation, and the planning of targeted interventions. Conclusion: The changing trends in C. difficile-related mortality likely reflect improvements in infection control and treatment practices over time. However, the marked differences between regions and racial groups point to ongoing gaps in healthcare access and delivery. These disparities highlight the need for more focused public health efforts and deeper investigation into the factors behind them.