Trends in Diarrhea-associated Mortality in Children Less Than 5 Years of Age in the United States, 2005–2024

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BACKGROUND: The introduction of rotavirus vaccines in the United States in 2006 and 2008 has had large impacts on reducing rotavirus- and diarrhea-associated healthcare utilization. We evaluated changes in diarrhea-associated mortality from 2005 to 2024 among children 1-59 months of age. METHODS: We examined diarrhea-associated deaths, identified by International Classification and Diagnostic codes related to diarrhea listed anywhere on the death certificate, reported to the National Center for Health Statistics from 2005 to 2024. Diarrhea-associated death rates were calculated using national census data. Rate ratios and 95% confidence intervals were calculated using Poisson regression. RESULTS: From 2005 to 2024, 6993 diarrhea-associated deaths of children 1-59 months old were reported. The rate of diarrhea-associated deaths decreased by 41%, from 2.36/100,00 in 2005-2006 to 1.38/100,000 in 2022-2024. Mortality rates were higher among infants 1-3 months old, males, Black children and non-Hispanic children. Differences in mortality rates across demographic groups decreased over time. Overall, 94% of diarrhea-associated deaths were of unspecified etiology. Before vaccine introduction, diarrhea-associated death rates were higher during the rotavirus season (January to June) within the 4-11 and 12-23 months age groups; however, no distinct seasonality was observed after vaccine introduction (2008-2024). CONCLUSIONS: Diarrhea-associated mortality has declined in the United States. The diminished seasonality of deaths during the rotavirus season in the age groups most susceptible to rotavirus suggests that vaccines likely contributed, among other factors, to declines in US diarrhea-associated mortality over the past 2 decades. However, the lack of specified etiology for most diarrhea-associated deaths precludes definitive attribution.

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