Rising Mortality Rates of Cholecystitis in the United States (1999-2020): A CDC WONDER Analysis

IntroductionCholecystitis, typically caused by gallstone obstruction, presents with fever and right upper quadrant pain and may lead to severe complications like sepsis or death if untreated. Acalculous cholecystitis, though less common, carries a higher mortality rate of 15–40% compared to the overall 3%, especially in elderly and comorbid populations. Laparoscopic cholecystectomy is the preferred treatment within 7–10 days of symptom onset, with risk assessment tools (e.g., APACHE, P-POSSUM) guiding urgency. Some high-risk patients may require percutaneous cholecystostomy. This study examines U.S. cholecystitis mortality trends from 1999 to 2020, focusing on age-adjusted mortality rates (AAMR) and disparities among elderly and geographically diverse populations, to inform future health strategies.MethodsThis study utilized mortality data from the CDC-WONDER database, analyzing deaths attributed to cholecystitis (ICD-10 code K81) in individuals aged ≥35 years from 1999 to 2020. As the dataset was publicly available and de-identified, IRB approval was not required. Adhering to STROBE guidelines, the analysis included variables such as age, gender, race or ethnicity, place of death, census region, urban-rural classification, and state. Crude death rates (CDRs) and age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Trends in AAMRs across demographic and geographic subgroups were evaluated using Joinpoint Regression software to compute Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs), with statistical significance assessed via Monte Carlo Permutation Tests. A p-value < 0.05 was considered significant.ResultsFrom 1999 to 2020, there were 72,843 cholecystitis-related deaths in the U.S., with a modestly increasing overall age-adjusted mortality rate (AAMR) and an average annual percentage change (AAPC) of 0.396%. The AAMR rose from 9.53 in 1999 to 10.7 per million in 2020, with a significant increase seen after 2012. Males consistently had higher mortality rates than females (AAMR: 12.06 vs. 8.40), with male mortality rising notably post-2013. Among racial groups, Black or African Americans had the highest AAMR (10.94), followed by Whites (9.80) and Asian or Pacific Islanders (7.93), with significant temporal shifts observed especially in Black individuals. Regionally, the West showed the highest AAMR (10.36), with West Virginia having the highest state-specific AAMR (13.15). Most deaths (78.7%) occurred in inpatient medical settings. Mortality sharply increased with age, with those aged ≥85 showing a crude rate of 224.6 per million. Urban-rural disparities revealed higher mortality in rural populations (AAMR: 11.48 vs. 9.23), and trends differed significantly across age, sex, race, and geography based on Cuzick and Kruskal-Wallis tests. DiscussionOur analysis of mortality trends due to cholecystitis in the United States from 1999 to 2020 revealed an overall rise in age-adjusted mortality rates (AAMRs), with a particularly steep increase observed from 2012 to 2020. Males consistently exhibited higher mortality than females, with a significant increase in AAMR among men, especially after 2013, while female trends remained largely stable. Racial disparities were evident, with Black individuals experiencing a notable decline in mortality from 2004 to 2011, likely reflecting healthcare reforms, whereas White individuals showed a steady rise in mortality. The highest mortality was seen in patients aged 85 and older, followed by those aged 75–84, largely due to comorbidities and surgical risks. Regionally, states such as West Virginia, Tennessee, and Oklahoma had the highest AAMRs, while Michigan, Florida, and New York had the lowest, potentially reflecting disparities in healthcare infrastructure. Urbanization did not significantly affect mortality trends. Despite women having a higher incidence of gallstones, men had worse outcomes, possibly due to stone composition and surgical complications.