S2117 Temporal Trends and Regional Variations in Mortality Due to Sepsis and Peritonitis Among US Adults: A 25-Year Analysis Using the CDC WONDER Database (1999-2023)

Introduction: Sepsis and peritonitis are critical medical emergencies with significant mortality in the U.S. Peritonitis can lead to sepsis, causing systemic inflammation, multi-organ failure, and immunosuppression. Despite medical advancements, combined mortality rates remain high, with notable disparities across demographics. Methods: We extracted 1999–2023 CDC WONDER multiple cause-of-death data for decedents ≥25 years focusing on the incidence of sepsis and peritonitis-related age-adjusted mortality rates (AAMR) per 100,000 individuals. Joinpoint Regression v5.2.0 calculated annual percent changes (APC) with 95% confidence intervals (CIs; P ≤ 0.05), stratified by year, sex, race, region, urbanization, and age group. Results: A total of 89,827 deaths were attributed to sepsis and peritonitis among adults aged ≥25 years in the U.S. from 1999-2023. Overall, the mortality rate increased over the study period (AAPC: 0.85%). Initially, AAMRs declined from 1.62 in 1999 to 1.40 in 2007 (APC: -1.86%), followed by an increase to 1.87 in 2023 (APC: 2.23%). Males exhibited higher AAMRs compared to females (1.77 vs 1.43). Males' AAMRs decreased from 1.88 in 1999 to 1.49 in 2005 (APC: -3.14%), then increased to 1.95 in 2023 (APC: 1.94%). Females' AAMRs declined from 1.39 in 1999 to 1.22 in 2009 (APC: -1.33%), then rose to 1.76 in 2023 (APC: 2.62%). Among racial groups, non-Hispanic American Indians had the highest AAMRs at 2.98, followed by non-Hispanic (NH) Blacks (1.98), Hispanics (1.84), NH Whites (1.53), and NH Asians (1.11). NH American Indians' AAMRs increased from 1.81 in 1999 to 3.55 in 2023 (APC: 3.88%). NH Asians' AAMRs rose from 0.87 in 2015 to 1.22 in 2023 (APC: 4.50%). Regionally, AAMRs were highest in the West (1.85), followed by the Midwest (1.55), South (1.55), and Northeast (1.41). Rural areas had higher AAMRs than urban areas (1.61 vs 1.53). Individuals aged ≥85 years had the highest crude mortality rates (8.18). Among states, New Mexico and Maine had the highest and lowest AAMRs, respectively (2.12 vs 1.15). Conclusion: Our findings reveal rising mortality trends from sepsis and peritonitis with higher mortality rates among males, NH Americans and geriatric populations. The burden was greater among the residents of West and rural regions highlighting geographical disparities. These disparities emphasize the need of targeted interventions and additional research to clarify the relation between peritonitis and sepsis.