S3158 Emerging Disparities in Gastric Ulcer Perforation Mortality in the United States: A CDC WONDER Database Analysis (1999-2020)

Introduction: Gastric ulcer perforation is a life-threatening condition with high mortality, driven by delayed diagnosis, severe presentations, and complex surgical management. Yet national data on mortality trends remains limited, making it difficult to assess the full burden and associated disparities. Using Centers for Disease Control and Prevention mortality data, this study examines U.S. trends and highlights high-risk populations through evaluation of demographic and geographic disparities. Methods: Using the CDC WONDER database, deaths attributed to ulcer perforations (K25.1-.2, .5-.6; K26.1-.2, .5-.6; K27.1-.2, .5-.6; K28.1-.2, .5-.6) were extracted for adults ≥25 years for identification of early onset trends that may be masked when focusing solely on older populations. Age-adjusted mortality rates (AAMRs) per million were calculated using the 2000 U.S. standard population. Joinpoint regression estimated annual percent changes (APCs), with significance defined by 95% confidence intervals (CI) excluding zero. Analyses followed STROBE guidelines. Results: Between 1999 and 2020, there were 46,730 deaths (AAMR 9.71 per million), with an overall decline in mortality (APC -2.64; CI -3.45 to -1.78). Men had a higher AAMR than women (10.62 vs 8.95). Male mortality declined markedly (APC -6.09; CI -6.83 to -5.34) before a significant post-2010 increase (APC 1.36; CI 0.42-2.31). Female trends were more variable, with a brief non-significant period, followed by two significant declines (APC -8.69 and -3.14), and a notable increase post-2014 (APC 3.93; CI 1.84-6.05). Patients aged 80-84 had the highest crude mortality rate (57.15). Racial disparities were pronounced: non-Hispanic (NH) Whites had the highest AAMR (9.85), followed by American Indian/Alaskan Natives (9.29) and NH Blacks (8.71); Hispanics had the lowest (5.93). Significant increases were observed among Hispanics after 2015 (APC 7.07; CI 1.27 to 13.2) with non-significant increases seen across all races. Regionally, the West had the highest AAMR (10.39), with the District of Columbia and Massachusetts marking the highest (16.50) and lowest (7.91) state-level AAMRs, respectively. Conclusion: While overall mortality from ulcer perforation has declined, demographic and geographic disparities, with significant recent increases, demonstrate its growing public health burden. Given its often nonspecific presentation and rapid progression, these findings call for renewed focus on timely recognition, risk stratification, and research in high-risk groups.