S1441 Trends in Peptic Ulcer Disease–Related Mortality Among Adults Aged ≥25 With Diabetes in the United States: A Retrospective Population-Based Analysis (1999–2020)

Introduction: Diabetes mellitus impairs ulcer healing through microvascular damage, immune dysfunction, and delayed gastric motility, increasing the risk of adverse peptic ulcer disease (PUD) outcomes. Monitoring mortality in this high-risk group is essential to guide prevention strategies. This study examined national trends in PUD-related mortality among U.S. adults aged ≥25 with diabetes from 1999 to 2020, focusing on temporal, demographic, and geographic patterns. Methods: We analyzed CDC WONDER data (1999–2020) for PUD-related deaths in adults ≥25 with diabetes mellitus (ICD-10: E10–E14, K25–K28). Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. Joinpoint regression was used to evaluate Annual percent changes (APCs). Data were stratified by sex, race/ethnicity, age, state, region, and 2013 urbanization level. Results: From 1999 to 2020, AAMR for PUD-related mortality in adults with diabetes declined from 6.3 to 3.1 per million (APC: 3.34%, CI: −4.88 to −1.78, P = 0.000032) with 15,792 deaths recorded. Men had higher AAMRs (4.1) than women (2.7). Mortality declined significantly in middle-aged adults until 2015 and in older adults until 2018. After 2015, mortality in middle-aged adults increased significantly (APC: 6.61%, P = 0.004), while no significant rise was observed in older adults, with overall APC decline in both groups. By race/ethnicity, the highest AAMRs were seen in non-Hispanic (NH) Asian or Pacific islanders (4.8), NH Blacks (4.7), Hispanics (4.4), NH American Indian/Alaska Natives (4.3) and NH Whites (3) populations. In Hispanics, a significant rise in mortality was observed from 2015 to 2020 (APC: +10.45%, CI: 1.20–20.53, P < 0.05), a pattern not observed in other racial groups. AAMR declined across all regions. The highest AAMR was observed in West (4.4), followed by Midwest (3.5), South (2.9) and Northeast (2.7). Metropolitan areas showed a significant rise in mortality from 2016 to 2020 (APC: 6.35%, CI: 1.40-11.55, P = 0.015). Conclusion: Although PUD-related mortality in adults with diabetes declined overall between 1999 and 2020, recent rise among middle-aged adults, Hispanics, and metropolitan areas since 2015 is concerning. These patterns may reflect delayed diagnosis, higher comorbidity burden, and increased use of gastrotoxic drugs. Addressing this reversal will require integrating gastrointestinal risk assessment into routine diabetic care, improving urban healthcare access, and tailoring public health outreach for high-risk populations.