P0564 - Where Adults With Malnutrition Die: A Nationwide Analysis of Mortality Settings Using CDC WONDER, 1999–2022

Rahul Kumar, MD¹, Avinash Nankani, MBBS², Tahreem Mari, MBBS³, Syed Shabbeer Hussain Rizvi, MBBS², Saifullah Khan, ³, Sunny Kumar, MD⁴, Diksha Kajal, MD⁵, Akshay Sharma, MBBS⁶, Miroslav Radulovic, MD¹
1North Central Bronx Hospital, Bronx, NY; 2Dow University of Health Sciences, Karachi, Sindh, Pakistan; 3Dow Medical College, Karachi, Sindh, Pakistan; 4Wright Center for Graduate Medical Education, Scranton, PA; 5Florida State University, Cape Coral, FL; 6Luminis Health Anne Arundel Medical Center, Annapolis, MD

Introduction: Malnutrition, characterized by over- or undernutrition, remains a serious concern in the United States (U.S.), affecting more than 30% of its patients. We assessed trends in malnutrition‐related mortality in the U.S. from 1999 to 2022 among adults (≥ 25 years old) to determine differences by age, sex, ethnoracial groups, urbanization, and census region.

Methods: This study analyzed death certificates from the CDC WONDER database, focusing on mortality caused by malnutrition in adults (≥ 25 years old) from 1999 to 2022. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) with 95% confidence intervals (CIs) were computed and categorized by year, age, gender, race, census region, state, and metropolitan status using joinpoint regression analysis.

Results: A total of 755,857 deaths were reported in patients with malnutrition. AAMR increased from 11.9 to 24.7 per 100,000 population between 1999 and 2022. The mortality trend declined from 1999 to 2006 (APC = –5.94; 95% CI: –7.98, –4.68; p< 0.000001), plateaued till 2013, then began to rise from 2013 to 2022 with an APC of 14.44 (95% CI: 13.81, 15.3; p< 0.000001) and an overall AAPC of 3.31 (95% CI: 3.08, 3.55; p< 0.000001). Persons 55-74 years of age (AAPC= 3.51; 95% CI: 3.35, 3.73; p< 0.000001), females (AAPC=3.53; 95 % CI: 3.27, 3.78; p< 0.000001), Non-Hispanic Whites (AAPC=3.67; 95% CI: 3.43, 3.90; p< 0.000001), residents of U.S. Western region (AAPC=4.01; 95% CI: 3.70, 4.35; p< 0.000001), and medium metropolitan areas (AAPC= 2.98; 95% CI: 2.75, 3.26; p< 0.000001) had the highest AAPCs in their respective groups.

Discussion: Reversing the earlier declining trends, malnutrition-related mortality has increased significantly over the past decade in the U.S. Disparities were evident, with the most pronounced increases seen in 55–74-year-olds, females, Non-Hispanic Whites, and residents of the Western U.S. and medium metropolitan areas. Targeted public health interventions and nutritional programs, ensuring food security and early detection are necessary to address and reduce the rising rates of malnutrition-related mortality among adults in light of these disparities.


Figure: Central illustration depicting malnutrition-related mortality among adults in the United States from 1999 to 2022 using CDC WONDER data. A total of 755,857 deaths were recorded during this period.
Top panel: Sex-stratified trends show AAMRs nearly doubled for both males (from 12.6 to 24.7) and females (from 11.2 to 24.5).
Middle panel: The overall AAMR peaked in 2022 at 24.7 per 100,000. Racial disparities were notable, with the highest 2022 AAMR in Black or African American individuals (27.6), followed by White (25.3), American Indian/Alaska Native (23.3), Hispanic/Latino (17.9), and Asian/Pacific Islander (13.0) populations.
Bottom panel: Regional analysis revealed consistently higher mortality in the Southern and Western U.S., with urban-rural stratification indicating elevated rates in non-core and small metro areas.

Disclosures:
Rahul Kumar indicated no relevant financial relationships.
Avinash Nankani indicated no relevant financial relationships.
Tahreem Mari indicated no relevant financial relationships.
Syed Shabbeer Hussain Rizvi indicated no relevant financial relationships.
Saifullah Khan indicated no relevant financial relationships.
Sunny Kumar indicated no relevant financial relationships.
Diksha Kajal indicated no relevant financial relationships.
Akshay Sharma indicated no relevant financial relationships.
Miroslav Radulovic indicated no relevant financial relationships.

Rahul Kumar, MD¹, Avinash Nankani, MBBS², Tahreem Mari, MBBS³, Syed Shabbeer Hussain Rizvi, MBBS², Saifullah Khan, ³, Sunny Kumar, MD⁴, Diksha Kajal, MD⁵, Akshay Sharma, MBBS⁶, Miroslav Radulovic, MD¹. P0564 - Where Adults With Malnutrition Die: A Nationwide Analysis of Mortality Settings Using CDC WONDER, 1999–2022, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.