P5566 - Nationwide Analysis of Mortality Trends in Enterocolitis Due to Clostridium Difficile from CDC WONDER Database and ARIMA Analysis (1999-2040)

Usman Afzal, MD¹, Anfal Hamza, MBBS², Arbaz Hassan, MBBS², Waqas Ahmed, MBBS², Farah Shehryar, MBBS³, Adeel Altaf, ⁴, Barika Fatima, ⁵, Abdul Eizad Asif, MBBS⁶, Ahmad Sarim Aziz, MBBS⁷, Talha Sajjad, MBBS, MD², Hamza Amjad, MBBS⁸
1MedStar Georgetown University Hospital, Washington, DC; 2Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan, Rahim Yar Khan, Punjab, Pakistan; 3Khyber Medical College, Peshawar, Pakistan, Peshawar, Sindh, Pakistan; 4Sheikh Zayed Medical College, Rahim Yar Khan, Rahim Yar Khan, Punjab, Pakistan; 5Ziauddin Medical College, Karachi, Sindh, Pakistan; 6Shalamar Medical and Dental College, Lahore, Pakistan, Lahore, Punjab, Pakistan; 7Azra Naheed Medical College, Lahore, Pakistan, Lahore, Punjab, Pakistan; 8Shiekh Zayed Medical College, Rahim Yar Khan, Pakistan, Rahim Yar Khan, Punjab, Pakistan

Introduction: Clostridium difficile infection (CDI) remains a leading cause of healthcare-associated gastrointestinal illness in the United States, particularly among older adults. This study aims to assess mortality patterns for CDI-related enterocolitis in U.S. adults aged ≥45 years from 1999 to 2023.

Methods: We conducted a retrospective analysis using CDC WONDER single cause-of-death data from 1999 to 2023, in individuals aged ≥45 years with enterocolitis due to Clostridium difficile (ICD-10 code A04.7) as the underlying cause of death. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population in gender, race, Hispanic origin, states, and 2013 urbanization framework. Joinpoint regression (JPR) was used to estimate trends through Annual Percent Change (APC) with 95% confidence intervals. Autoregressive Integrated Moving Average (ARIMA: 4,0,0) approach was applied to predict annual AAMRs till 2024, followed by the Ljung-box test for validation of model.

Results: Enterocolitis claimed 127,813 lives from 1999 to 2023, with the overall AAMR of 6.55 which is estimated to rise to 7.15 (95% CI: 1.91-12.39; Ljung-box test p-value = 0.358) till 2040. The highest APCs were observed between 1999–2005, with males showing an APC of 35.57 (95% CI: 31.29–43.74, p=0.00) and females 36.70 (95% CI: 32.60–42.19, p=0.00). From 2016 to 2023, both Hispanic and Non-Hispanic populations exhibited significant declines in mortality trends, with APCs of –15.45 (95% CI: –19.73 to –12.83, p=0.00) and –16.06 (95% CI: –30.87 to –8.11, p=0.007), respectively. Among U.S. Census regions, Region 3: South exhibited the highest increase in mortality from 1999–2002 (APC: 63.35, 95% CI: 45.13–123.89, p=0.00), followed by the steepest decline in later years (APC: –17.00, 95% CI: –19.72 to –14.94, p=0.000). Among racial groups, American Indians showed the most significant decline from 2016–2023 (APC: –17.14, 95% CI: –31.21 to –10.55, p=0.00). Across all 2013 urbanization categories, mortality rates increased from 1999–2005 with APCs ranging from 31.44 to 40.92, followed by a consistent decline in subsequent years, with APCs ranging from –0.58 to –7.58.

Discussion: Mortality from C. difficile enterocolitis has significantly fluctuated over the past 25 years. Despite improvements, disparities persist across race, sex, and region. Sustaining current control measures and strengthening targeted prevention efforts are essential to maintain progress and close existing gaps.


Figure: Trends of Age Adjusted Mortality Rates (AAMR)

Disclosures:
Usman Afzal indicated no relevant financial relationships.
Anfal Hamza indicated no relevant financial relationships.
Arbaz Hassan indicated no relevant financial relationships.
Waqas Ahmed indicated no relevant financial relationships.
Farah Shehryar indicated no relevant financial relationships.
Adeel Altaf indicated no relevant financial relationships.
Barika Fatima indicated no relevant financial relationships.
Abdul Eizad Asif indicated no relevant financial relationships.
Ahmad Sarim Aziz indicated no relevant financial relationships.
Talha Sajjad indicated no relevant financial relationships.
Hamza Amjad indicated no relevant financial relationships.

Usman Afzal, MD¹, Anfal Hamza, MBBS², Arbaz Hassan, MBBS², Waqas Ahmed, MBBS², Farah Shehryar, MBBS³, Adeel Altaf, ⁴, Barika Fatima, ⁵, Abdul Eizad Asif, MBBS⁶, Ahmad Sarim Aziz, MBBS⁷, Talha Sajjad, MBBS, MD², Hamza Amjad, MBBS⁸. P5566 - Nationwide Analysis of Mortality Trends in Enterocolitis Due to <i>Clostridium Difficile</i> from CDC WONDER Database and ARIMA Analysis (1999-2040), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.