Trends in nontraumatic intestinal perforation-related mortality among adults in the United States from 1999 to 2020: A nationwide CDC WONDER analysis

To characterize mortality trends associated with nontraumatic intestinal perforation (NIP) in the United States, which continue to remain poorly defined. NIP is defined as the loss of continuity of the bowel wall in which external trauma as an etiology has been excluded. NIP is a serious gastrointestinal emergency with limited national mortality trend data, particularly across various demographic and regional subgroups. NIP-related mortality data were extracted from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database from 1999 to 2020. We analyzed age-adjusted mortality rates (AAMR) per 100,000 individuals and annual percent change (APCs) with 95% confidence interval (CI) in patients ≥ 15 years based on gender, race and geographical region. Overall, there were 122,161 NIP-related deaths among patients aged ≥ 15 years, with an increase in AAMR from 1.90 in 1999 to 2.0 in 2009 (APC: 0.19; CI: -0.33 to 0.71), and a gradual increase to 2.40 in 2020 (APC: 1.26; CI: 0.80 to 1.71). AAMR was lower in females compared to males in 1999 (2.0 vs 1.90; CI: 1.90 to 2.0). However, in 2020, AAMR values increased in females (2.20 vs 2.0; CI: 2.40 to 2.60; P < .05). AAMRs were higher in patients reported as non-Hispanic compared to Hispanic/Latinos (2.10 vs 1.50; CI: 2.10 to 2.10; P < .05). Variation in AAMR values across census regions was not significant. NIP-related AAMR was higher in nonmetropolitan than metropolitan areas (2.90 vs 1.90; CI: 2.10 to 2.10; P < .05). NIP-related mortality has risen among patients' ≥15 years. Higher AAMRs in females, non-Hispanic individuals, and nonmetropolitan populations highlight the need for targeted preventive efforts.