S1442 Trends and Disparities in Gastrointestinal Bleeding Mortality Among Older Adults in the US (1999–2020)

Introduction: Gastrointestinal (GI) bleeding is a significant cause of hospitalizations and mortality among older adults. While prior studies have examined GI bleeding in general populations, limited research has focused specifically on mortality trends among U.S. adults aged 65 and older. This study aims to analyze GI bleeding–related mortality among older adults. Methods: We analyzed the CDC WONDER database (1999–2020) for deaths attributed to GI bleeding (ICD-10 codes: K25.0, K25.2, K25.4, K25.6, K26.0, K26.2, K26.4, K26.6, K27.0, K27.2, K27.4, K27.6, K28.0, K28.2, K28.4, K28.6, K29.0, K62.5, K92.0, K92.1, K92.2) among adults aged ≥65 years. Mortality data were stratified by sex, race/ethnicity, urban-rural classification, geographic region, and U.S. state. Age-adjusted mortality rates (AAMRs) per 100,000 population and average annual percent change (AAPC) with 95% confidence intervals (CI) were calculated using Joinpoint regression analysis. Results: From 1999 to 2020, there were 575,343 reported deaths due to GI bleeding among older adults in the U.S., with an overall declining trend in AAMRs (AAPC = -1.56). AAMRs decreased significantly from 82.7 in 1999 to 55 in 2009 (APC = -4.23, 95% CI: -4.95 to -3.71), remained stable from 2009 to 2018 (APC = -0.05, 95% CI: -1.78 to 0.69), but rose significantly to 63 in 2020 (APC = 5.42, 95% CI: 1.43 to 7.46). Throughout the study period, men had a higher AAMRs than women (75.4 vs 53.1), with comparable declines in mortality (AAPC: -1.56 vs -1.52). Racial disparities were notable, with the highest AAMR among Non-Hispanic Black or African American (76.4) and the lowest among Non-Hispanic Asian or Pacific Islanders (46.4). Mortality rates were higher in non-metropolitan areas (72.4%) than in metropolitan areas (60.1%). Regionally, the Midwest and Northeast (65.8) exhibited the highest AAMRs, while Vermont (88.7) and West Virginia (86.1) had the highest state-level rates; Arizona (44.7) and Georgia (44.4) had the lowest. Conclusion: While overall mortality from GI bleeding among older adults has declined over the past 2 decades, significant disparities persist across sex, race, and geographic regions, with recent data indicating a concerning rise in mortality. These patterns highlight a need for targeted public health policies and medical strategies to improve access to preventive and therapeutic care.