P4166 - Analysis of Mortality Trends Among Adults With Peptic Ulcer Disease in the United States: Insights From CDC WONDER (1999-2023)

Maha Sajjad, MBBS¹, Sana Altaf, MBBS², Sajjad U.. Hasan, MBBS, MPH³, Muhammad Imaz Bhatti, MBBS¹, Maryam Saghir, MBBS⁴, Sahil Jairamani, MBBS⁵, Zahin Shahriar, MBBS⁶
1King Edward Medical University, Lahore, Lahore, Punjab, Pakistan; 2Deccan College of Medical Sciences, Irving, TX; 3Amna Inayat Medical College, Sheikhupura, Pakistan, Lahore, Punjab, Pakistan; 4Jinnah Sindh Medical University, Karachi, Sindh, Pakistan; 5Liaquat University of Medical and Health Science, Jamshoro, Pakistan, Jamshoro, Sindh, Pakistan; 6Dhaka Medical College and Hospital, Dhaka, Dhaka, Bangladesh

Introduction: Peptic ulcer disease (PUD) persists as a significant public health concern in the U.S., associated with serious complications including bleeding and perforation, and contributing to over 5,000 deaths in 2023. This study analyzes temporal trends in PUD-related mortality and associated demographic disparities among U.S. adults aged ≥25 years from 1999 to 2023.

Methods: PUD-related mortality data were acquired from the CDC WONDER Multiple Cause of Death database using the ICD-10 codes K25, K26, K27. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 individuals were computed. Temporal trends were analyzed using Joinpoint regression to estimate the annual percent change (APC) and the average annual percent change (AAPC), with 95% confidence intervals (CIs).

Results: Between 1999 and 2023, 188,792 deaths were attributed to PUD. The overall trend showed a significant decline, with an AAPC of -3.27% (95% CI: -3.95 to -2.59). This decrease was most rapid from 1999 to 2007 (APC: -8.31%), moderated from 2007 to 2013 (APC: -4.17%), and stabilized between 2013 and 2018 (APC: -0.17%). A concerning reversal occurred from 2018 to 2021, with a sharp increase (APC: 7.47%), followed by a slight, non-significant decline from 2021 to 2023 (APC: -2.78%). Men experienced higher mortality than women (AAMR: 4.29 vs. 2.92). Racial and ethnic disparities were evident: non-Hispanic (NH) American Indian/Alaska Native individuals had the highest AAMR (3.84), followed by NH Black (3.72), NH White (3.53), NH Asian/Pacific Islander (3.50), and Hispanic (2.85) populations. Regionally, the West exhibited the highest AAMR (4.41), followed by the Midwest (3.62), South (3.24), and Northeast (2.90). Most deaths occurred in medical facilities (65.9%) or at the decedent’s home (15.7%). States with the highest AAMRs included the District of Columbia, California, Vermont, Wyoming, and North Dakota. Non-metropolitan areas demonstrated higher AAMRs (3.89) than metropolitan areas (3.34). Adults aged 65 and older had the highest CMR (14.11).

Discussion: While PUD mortality in the United States decreased overall during the 25-year period, a significant recent increase (2018-2021) and persistent demographic and geographic disparities underscore ongoing challenges. Continued surveillance and tailored public health strategies focused on high-risk populations are essential to mitigate these disparities and improve outcomes.


Figure: Figure 1: Overall age-adjusted mortality rates per 100,000 persons
Figure 2: Sex-stratified trends (age-adjusted mortality rates per 100,000 persons)
Figure 3: Racial disparities (age-adjusted mortality rates per 100,000 persons)
Figure 4: Urbanization trends (age-adjusted mortality rates per 100,000 persons)
Figure 5: State-stratified trends (age-adjusted mortality rates per 100,000 persons)
Figure 6: Census region-stratified trends (Age-adjusted mortality rates per 100,000 persons)

Disclosures:
Maha Sajjad indicated no relevant financial relationships.
Sana Altaf indicated no relevant financial relationships.
Sajjad Hasan indicated no relevant financial relationships.
Muhammad Imaz Bhatti indicated no relevant financial relationships.
Maryam Saghir indicated no relevant financial relationships.
Sahil Jairamani indicated no relevant financial relationships.
Zahin Shahriar indicated no relevant financial relationships.

Maha Sajjad, MBBS¹, Sana Altaf, MBBS², Sajjad U.. Hasan, MBBS, MPH³, Muhammad Imaz Bhatti, MBBS¹, Maryam Saghir, MBBS⁴, Sahil Jairamani, MBBS⁵, Zahin Shahriar, MBBS⁶. P4166 - Analysis of Mortality Trends Among Adults With Peptic Ulcer Disease in the United States: Insights From CDC WONDER (1999-2023), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.