S2115 Temporal and Demographic Trends in Infective Gastroenteritis-Related Mortality Among US Adults: A 25-Year Nationwide Analysis (1999-2023)

Introduction: Infective gastroenteritis remains a leading cause of gastrointestinal-related mortality in the United States (U.S.). Despite advancements in healthcare, the mortality burden remains significant, driven in part by the emergence of antibiotic-resistant pathogens, evolving healthcare practices, increasing prevalence of immunosuppressive conditions, and demographic shifts such as an aging population. However, mortality trends especially with regard to demographic disparities remain insufficiently explored. Methods: We extracted 1999–2023 CDC WONDER multiple cause-of-death data for decedents ≥25 years focusing on the incidence of infective gastroenteritis-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: From 1999 to 2023, a total of 304,378 deaths were attributed to infective gastroenteritis. Overall, the AAMR significantly increased from 1.5 in 1999 to 4.9 in 2005 (APC: 23.4; P< 0.001), followed by a gradual increase to 7.7 by 2010 (APC: 12.4; P = 0.09). After 2010, however, the AAMR declined significantly, reaching 5.0 in 2023 (APC: −4.0; P = 0.008). Sex disparities emerged while males had higher overall mortality (5.4 vs 5.3), females showed sharper initial increase (APC = 25.5 vs 22.8, P < 0.05), sustained growth through 2011 (APC = 10.1, P = 0.008), and a steeper decline by 2023 (APC = -4.5 vs -4.1, P < 0.05), revealing more pronounced mortality fluctuations than males. Non-Hispanic (NH) American Indians had the highest AAMR (6.4), followed by NH White (5.6), NH Blacks (4.8), Hispanics (3.9) and NH Asians (2.3). The Northeast demonstrated the highest AAMR (5.9) among all regions, with urban areas slightly exceeding rural areas (5.5 vs 5.3, respectively). Among States, Rhode Island and Hawaii showed the highest and lowest AAMRs (10.3 and 2.2), respectively. Mortality rates were the highest in the 85+ age group over time (AAPC: 4.37; P < 0.001). Conclusion: Marked disparities in mortality from infective gastroenteritis persist. Males, NH American Indians, individuals in the Northeast, metropolitan areas and geriatric populations show the highest mortality. These findings call for future research to find the causative reasons in vulnerable subgroups. Furthermore, targeted interventions should be planned to address demographic and geographic inequalities.