Trends and disparities in procedure-related mortality among older U.S. adults with digestive system malignancies: A 24-year analysis of the CDC WONDER database.

Abstract

e15717 Background: Older adults with digestive system malignancies (DSM) frequently undergo diagnostic and therapeuticprocedures and are vulnerable to procedure-related complications. Understanding national mortalitytrends and disparities can inform risk stratification and peri-procedural care. Methods: Using CDC WONDER (1999-2023), we conducted a retrospective population-based analysis ofprocedure-related mortality (Y83-Y84) among U.S. adults ≥65 years with DSM (C15-C26).Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 were calculated andstratified by year, sex, race, census region, state, and metropolitan status. Temporal trends wereevaluated using Joinpoint regression to estimate annual percent change (APC) with 95% confidenceintervals; statistical significance was defined as P < 0.05. Results: From 1999 to 2023, 22,624 procedure-related deaths occurred among older adults with DSM(58.9% male). The overall AAMR declined from 3.42 in 1999 to 1.05 in 2023. Trend analysisrevealed three distinct phases: a decrease through 2015 (APC −6.42%; 95% CI −7.35 to −5.47),a marked increase from 2015–2021 (APC 18.81%; 95% CI 12.24 to 25.76), and a sharp declinefrom 2021–2023 (APC −45.64%; 95% CI −58.82 to −28.23). The cumulative APC was −5.06%(95% CI −7.49 to −2.56; P < 0.001).Mortality increased with age, peaking in patients ≥85 years(CMR 3.92) compared to those 65–74 years (CMR 1.33). Men had a significantly higher AAMRthan women (2.60 vs 1.28). While the White population accounted for the majority of deaths(86.87%; AAMR 2.13), Asian/Pacific Islanders had the highest mortality rate (AAMR 2.32)despite representing the smallest share of deaths (0.55%).Geographically, the West reportedthe highest mortality (CMR 2.60; AAMR 2.67), followed by the Midwest, South, and Northeast.At the state level, Nebraska (3.82) and Vermont (3.70) reported the highest AAMR, withMassachusetts lowest (1.18). Non-metropolitan areas showed higher AAMR than metropolitancenters (2.46 vs 2.06) despite significantly fewer total deaths. Conclusions: Procedure-related mortality among older adults with DSM declined overall but showed a markedrise during 2015–2021 followed by a sharp decline. Persistent disparities by age, sex, race,geography, and metropolitan status highlight the need for improved peri-procedural riskstratification and targeted interventions.