Epidemiological trends and disparities in mortality from gastrointestinal tract obstruction in the United States: A CDC WONDER analysis (1999–2023)

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Gastrointestinal obstruction is an important cause of morbidity and mortality in the United States, but full descriptions of time trends and disparities are poorly defined. This study aims to examine trends in mortality from gastrointestinal obstruction over a span of 25 years in various demographics and geographic locations within the United States from 1999 to 2023. We conducted a retrospective analysis using CDC WONDER multiple cause-of-death data. Deaths were identified when gastrointestinal obstruction was listed as either the underlying or a contributing cause of death. Age-adjusted mortality rates (AAMR) per 1,00,000 population were calculated and stratified by sex, race/ethnicity, census region, urbanization level, and state. Joinpoint regression analysis identified inflection points and estimated annual percent changes (APC) and average annual percent changes. Between 1999 and 2023, 5,20,045 deaths from gastrointestinal obstruction were identified. Overall, AAMR declined from 10.76 per 1,00,000 in 1999 to 8.56 in 2014, followed by an increase to 9.95 in 2023. Joinpoint analysis revealed 3 distinct phases: significant decline (1999-2012, APC -1.78%, P < .001), plateau (2012-2018, APC -0.09%, P = .862), and significant increase (2018-2023, APC 3.43%, P < .001). Males consistently exhibited higher mortality than females throughout the study period (2023: 10.44 vs 9.59 per 1,00,000). Substantial racial disparities persisted, with non-Hispanic Black individuals demonstrating the highest AAMR (12.95 in 2023), 1.32-fold higher than non-Hispanic white individuals. Rural areas maintained consistently higher mortality than urban areas; data from 2020 are presented for urbanization comparisons, as this was the most recent year with complete rural-urban classification data available from CDC WONDER at the time of analysis (2020: 10.99 vs 8.54 per 1,00,000). State-level age-adjusted mortality rates varied nearly 2-fold, ranging from 6.86 in Florida to 13.15 in Vermont. Most deaths occurred in medical facilities (66.8%). After a decade of declining gastrointestinal obstruction mortality, rates have increased significantly since 2018 across nearly all demographic groups. Persistent disparities by race, geography, and urbanization underscore the need for targeted interventions and equitable access to timely surgical care. The reversal of favorable trends warrants urgent investigation into contributing factors and implementation of prevention strategies.

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