Trends in diverticular disease mortality among United States adults (1999–2020) by gender, race, and geographic region

Abstract

BACKGROUND

Diverticular disease of the intestine is a major gastrointestinal cause of mortality in the United States and the world. It is one of the most common gastrointestinal conditions responsible for hospital admissions.

AIM

To identify mortality trends of diverticular disease among adults in the United States, examining regional and demographic variations, as these have not been previously studied. These trends are highly beneficial to studying disease burden and vulnerable populations.

METHODS

Diverticular disease-related mortality data were extracted as age-adjusted mortality rates (AAMRs) from death certificate data of the CDC WONDER database using International Statistical Classification of Diseases and Related Health Problems-10^th Revision codes K57.0 to K57.9 from 1999 to 2020 in adults ≥ 45 years of age per 100000 population. These AAMRs were stratified by gender, ethnicity, and demographics and analyzed using Joinpoint regression to determine annual percent changes (APCs) and assess trend changes.

RESULTS

Between 1999 and 2020, a total of 114044 diverticular disease-related deaths were reported among adults ≥ 45 years of age. Our analysis reports progressive decline in mortality with AAMR decreasing from 6.7 in 1999 to 6.1 in 2003 [APC: -2.60; 95% confidence interval (CI): -3.79 to -0.33], after which it further declined to 3.6 in 2013 (APC: -5.16; 95%CI: -7.26 to -4.74), with a minimal decrease to 3.5 in 2020 (APC: -0.65; 95%CI: -1.87 to 1.51). Women had a higher AAMR (4.8) than men (3.8) throughout the study period. The racial analysis reported the highest overall AAMR in non-Hispanic (NH) Whites (4.7), followed by NH Black or African American (3.9), Hispanic or Latino (3.1), and Asian or Pacific Islander (1.5), with unreliable data for the American Indian or Alaska Native population. States in the top 90^th percentile, such as Wyoming and Vermont, had approximately double the AAMRs compared to states in the bottom 10^th percentile. The mortality rate also exhibited regional disparities, with an overall AAMR higher in the Midwest and West regions (4.7) compared to the Northeast and South regions (4.2), and higher in nonmetropolitan areas (5.4) compared to metropolitan areas (4.2).

CONCLUSION

Although the annual mortality of diverticular disease has decreased since 1999, there are certain demographic and regional disparities, with mortality rates higher in women, NH White and NH Black adults, Western regions, and nonmetropolitan areas. Further research is needed to identify factors responsible for these disparities and plan appropriate interventions.

Keywords: Mortality; Diverticular disease; Demographic trends; Regional trends; Analysis

Core Tip: There is limited comprehensive data on mortality rates due to diverticular disease. This study aims to investigate the mortality trends of diverticular disease over a two-decade period through demographic and regional stratification. Overall mortality has decreased over two decades; however, females and non-Hispanic whites have higher mortality rates. The study also identifies states and regions showing higher mortality rates. The study suggests that further research is necessary to identify the factors contributing to demographic and regional disparities in mortality, thereby enhancing public health measures for vulnerable populations.