S3045 Trends and Disparities in Mortality Associated With Intestinal Fistulas in the United States From 1999 to 2020

Introduction: Intestinal fistulas are uncommon but serious gastrointestinal conditions associated with substantial morbidity and mortality. Despite their clinical impact, national data on long-term mortality trends and demographic disparities are limited. This study aimed to assess temporal trends and population-level disparities in intestinal fistula-associated mortality among U.S. adults aged 45 years and older from 1999 to 2020. Methods: Retrospective analysis of Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was performed. For intestinal adhesions causing obstruction, International Classification of Diseases-10 code K63.2 was employed. Age-adjusted mortality rates (AAMR) and crude death rates (CDR) per 100,000 persons were determined. Average annual percentage change (AAPC) was determined using Joinpoint regression. Temporal trends were analyzed in sex, race, geographical distribution and patient age-related mortality. Results: A total of 15,672 deaths were reported. AAMRs showed a slight increase from 1999-2005 (AAPC: 0.41; P = 0.72) followed by a sharper decline from 2005-2020 (AAPC: -2.99; P < 0.001), resulting in an overall AAMR of 0.58 (AAPC: -2.03; P < 0.001). Females had a higher AAMR than males (0.67 vs 0.51) but showed a lesser decline in AAPC: -1.58; P < 0.001) than AAPC: -2.45; P < 0.001). Among races, non-Hispanic (NH) American Indians/Alaskan Natives and NH Black/African Americans had the highest AAMRs (0.75 and 0.74, respectively), followed by NH White (0.59), Hispanic (0.45), and NH Asian/Pacific Islander (0.31). All races saw a decline in AAMR, with the greatest decline seen for NH AAPC: -3.48; P < 0.001). Geographically, Midwest had the highest AAMR (0.67) followed by South (0.61). All census regions saw a decline in AAMR, with the greatest decline seen for AAPC: -2.64; P < 0.001). Nonmetropolitan areas had a disproportionately higher AAMR than metropolitan areas (0.72 vs 0.57). However, metropolitan areas showed a far greater decline in AAPC: -2.47; P < 0.001) than nonmetropolitan AAPC: -0.89; P < 0.001). CDR increased with advancing age, with the highest CDR seen for 85+ years (2.11). All age groups saw decline in CDR, with the greatest decline seen for 75-84 (AAPC: -2.56; P < 0.001). Conclusion: Although there was a significant decrease in intestinal fistula associated-mortality, persistent disparities exist. Elderly females, NH American Indians and Blacks, residents of Midwest and nonmetropolitan areas experienced higher mortality rates.