P4545 - Unveiling Two Decades of Clostridioides difficile Enterocolitis: Demographic Disparities and Mortality Trends - A National Database Analysis (1999–2022)

Mohamed A. Ebrahim, MD¹, Mohammad Adam, MD, MSc², Marwan Ahmed, MD³, Bilal Makhdoom, MD⁴, Kanwal Tagar, MD¹, Dolly Ewili, MD¹, Muhammad Sohaib Alvi, MBBS, MD¹, Parth Patel, MD¹
1Ascension Saint Joseph Hospital, Chicago, IL; 2University of Missouri - Kansas City School of Medicine, Kansas City, MO; 3Parkview Medical Center, Pueblo, CO; 4Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL

Introduction: Clostridium difficile infection is a major cause of healthcare-associated gastrointestinal illness, primarily affecting older adults and those with weakened immune systems. Treatment advances include the FDA-approved antibiotic fidaxomicin (2011), which is more effective than vancomycin for reducing recurrence, especially in recurrent cases. Despite treatment progress, C. diff remains a public health concern with varying mortality rates across demographics and regions.

Methods: A detailed underlying cause of mortality due to C. diff infection (ICD-10 code A04.7) was conducted using the CDC-WONDER database from 1999 to 2022. Age-adjusted mortality rates (AAMR) were calculated using the 2000 US standard population, and temporal trends were evaluated through Joinpoint regression, calculating average annual percent change (AAPC). Mortality was stratified by gender, race/ethnicity, urbanization level, and geographic region, with data visualization performed using R software (version 4.2.0).

Results:

From 1999–2022, enterocolitis due to Clostridium difficile caused 116,979 deaths, with an overall age-adjusted mortality rate (AAMR) of 1.51. Mortality rose from 0.28 in 1999, peaked at 2.36 in 2008, then declined to 0.98 in 2020, stabilizing around 1.00 in 2021–2022. The >65 years age group had the highest mortality, increasing from 2.15 in 1999 to 17.46 in 2011, then declining to 6.67 in 2022. For those < 65 years, mortality remained lower, rising from 0.01 in 1999 to a peak of 0.28 in 2015, then decreasing to 0.16 in 2022. The analysis highlighted racial and ethnic disparities. Non-Hispanic Whites had an AAMR of 1.59, Non-Hispanic Blacks 1.27, and Hispanics 1.12. Gender analysis showed females with a slightly higher average AAMR of 1.52 compared to males at 1.50. Urban areas had an AAMR of 1.59 compared to 1.42 in rural areas. Regionally, the Northeast had the highest AAMR at 1.76, followed by the Midwest (1.61), South (1.40), and West (1.39). Rhode Island (3.09), Ohio (2.38), Maine (2.37), Missouri (2.32), and Maryland (2.23) had the highest AAMR.

Discussion: This study identifies significant trends in C. diff mortality across demographics such as age, race/ethnicity, urbanization, region, and sex. Mortality rates fluctuated over time, peaking in the mid-2000s, followed by a decline then stabilization. Higher mortality was seen among older adults, non-Hispanic whites, urban areas, and females. Regionally, the Northeast consistently had the highest mortality rates.


Figure: Trends in Age-Adjusted Mortality Rates for enterocolitis caused by Clostridium difficile in the United States, 1999-2022

Disclosures:
Mohamed Ebrahim indicated no relevant financial relationships.
Mohammad Adam indicated no relevant financial relationships.
Marwan Ahmed indicated no relevant financial relationships.
Bilal Makhdoom indicated no relevant financial relationships.
Kanwal Tagar indicated no relevant financial relationships.
Dolly Ewili indicated no relevant financial relationships.
Muhammad Sohaib Alvi indicated no relevant financial relationships.
Parth Patel indicated no relevant financial relationships.

Mohamed A. Ebrahim, MD¹, Mohammad Adam, MD, MSc², Marwan Ahmed, MD³, Bilal Makhdoom, MD⁴, Kanwal Tagar, MD¹, Dolly Ewili, MD¹, Muhammad Sohaib Alvi, MBBS, MD¹, Parth Patel, MD¹. P4545 - Unveiling Two Decades of <i>Clostridioides difficile</i> Enterocolitis: Demographic Disparities and Mortality Trends - A National Database Analysis (1999–2022), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.