S2069 A 22-Year Nationwide Analysis of Gastrointestinal Infection Mortality in the United States: The Burden of Clostridioides difficile and Other Enteric Pathogens

Introduction: Gastrointestinal (GI) infections are a persistent public health concern in the United States and worldwide, with Clostridioides difficile recognized as a leading cause of antibiotic-associated diarrhea (AAD) and infectious colitis. This study assessed 22-year trends in age-adjusted mortality rates (AAMR) for C. difficile and other GI Infections to evaluate their respective burdens and temporal patterns. Methods: This was a cross-sectional retrospective study. AAMR were obtained using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC Wonder) Multiple Cause of Death database from 1999 to 2020. Intestinal infectious diseases were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes A00–A09. C. difficile defined as A04.7 was analyzed separately while other GI infections included all remaining codes in the A00–A09 range. AAMR per 100,000 population were analyzed using Joinpoint Regression. Mortality trends were modeled separately for each group, and differences in temporal patterns were evaluated descriptively. Statistical significance was set at P < 0.05. Results: For C. difficile, AAMRs increased significantly from 1999 to 2005 (annual percentage change [APC]: 36.6%, P < 0.0001) and continued to rise at a slower pace from 2005 to 2011 (APC: 3.8%, P = 0.006). This was followed by a non-significant decline from 2011 to 2016 (APC: -5.3%, P = 0.072) and a significant decrease from 2016 to 2020 (APC: -14.3%, P < 0.0001). In contrast, mortality from other GI infections showed no significant trend from 1999 to 2007 (APC: -1.4%, P = 0.573), followed by a sharp and statistically significant increase from 2007 to 2010 (APC: 121.7%, P < 0.0001), and a non-significant decline from 2010 to 2020 (APC: -4.5%, P = 0.085). While both groups exhibited changes in mortality patterns over time, C. difficile demonstrated a sustained rise followed by a significant decline, suggesting the impact of clinical interventions. Other GI infections showed a brief but extreme spike, without a lasting trend. No coincident joinpoints were observed between the 2 groups, indicating distinct temporal trajectories. Conclusion: C. difficile mortality rose steeply in the early 2000s and declined in the following decade, likely reflecting improved prevention and treatment strategies. Other GI pathogens demonstrated a brief mortality spike but lacked sustained upward trends. Continued surveillance is essential to monitor evolving epidemiologic patterns.