Rising Mortality Rates and Demographic Disparities in Duodenal-Ulcer Related Deaths in the United States (1999-2020)

Introduction: Duodenal ulcers, a subtype of peptic ulcer disease (PUD), are open sores in the initial part of the small intestine caused by an imbalance between gastric acid and mucosal defenses. This imbalance commonly results from Helicobacter pylori infection and non-steroidal anti-inflammatory drug (NSAID) use, with additional risk factors including smoking and alcohol. Duodenal ulcer-related mortality is primarily due to complications such as bleeding, and studies indicate higher death rates in patients with malignancy-associated ulcers. MethodsThis observational study analyzed mortality trends due to duodenal ulcers in individuals aged 35 years and older in the United States from 1999 to 2020, using data from the CDC-WONDER database. The dataset, which includes de-identified death certificate information from all 50 states and the District of Columbia, identified deaths using ICD-10 code K26. Following STROBE guidelines, the study extracted data on demographics, location of death, and geographic variables. Crude death rates and age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Mortality patterns were assessed across gender, race or ethnicity, census regions, states, and urban versus rural areas. Joinpoint Regression Program 5.0.2 was used to evaluate temporal trends by calculating annual percentage changes (APCs) and average annual percentage changes (AAPCs), with statistical significance assessed through Monte Carlo Permutation Tests and two-tailed t-tests (p < 0.05).ResultsFrom 1999 to 2020, duodenal ulcer-related mortality in the U.S. showed a declining overall trend, with 52,674 total deaths and an average AAMR of 7.158 per 1,000,000 (AAPC = -1.69; 95% CI: -2.49 to -0.88). The AAMR dropped sharply from 1999 to 2007 (APC = -6.47) before plateauing (2007–2014) and rising again from 2014–2020 (APC = 4.84). Males consistently had higher AAMRs than females, though both sexes followed a similar trend of decline followed by a post-2013 rise. Racial disparities were evident, with White individuals having the highest AAMR (7.27), followed by Asian/Pacific Islanders (6.20) and Black/African Americans (6.08), all showing initial declines and recent uptrends. Regionally, the West had the highest AAMR (8.83), while states like California and Washington had almost double the rates of lower-mortality states like Virginia and Florida. Elderly individuals, especially those 85+, had the highest crude mortality rate (119.43), with a clear gradient by age. Most deaths occurred in inpatient settings (76.2%). Urban areas had a more pronounced decline (AAPC = -2.63*) compared to rural areas (-0.07), with a significant difference in trend (P = 0.01). Statistical tests confirmed significant variations across sex, age, race, and geography.DiscussionOur analysis of duodenal ulcer-related mortality in the U.S. from 1999 to 2020 revealed an overall decline in age-adjusted mortality rates (AAMRs), with the steepest drop occurring from 1999 to 2007, followed by a slower decline until 2014 and a slight increase through 2020. This trend aligns with earlier studies and highlights shifting epidemiological patterns. Notably, males exhibited higher mortality rates than females, likely due to higher rates of smoking and alcohol use. Contrary to past assumptions, white individuals had higher mortality than Black or Asian populations, with a notable uptick in white mortality after 2014. Older adults, particularly those over 75, experienced the highest mortality, possibly due to increased complications like ulcer perforation. Geographically, the West showed the highest regional mortality rates, with substantial variability among states. The observed decline is likely due to improved treatments and preventive strategies, though the recent increase may be linked to factors like the rising use of direct oral anticoagulants.