S277 Disparities and Trends in Cholecystitis-Related Mortality Among Diabetic Adults in the United States, 1999 to 2020: A Population-Based Analysis Using CDC WONDER

Abstract

Introduction: Cholecystitis, a common gallstone disease complication, may pose a higher mortality risk in diabetic patients due to immunometabolic dysfunction and delayed diagnosis. However, national trends and demographic disparities in cholecystitis-related mortality among diabetic adults remain poorly characterized. Methods: We analyzed CDC WONDER multiple cause-of-death data (1999 to 2020), identifying deaths listing both diabetes mellitus (ICD-10 E10–E14) and cholecystitis (K81). Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated for U.S. adults aged ≥25 years and assessed using joinpoint regression, stratified by sex, race/ethnicity, age groups, Census region, state, and 2013 urbanization level. Results: From 1999 to 2020, AAMR for cholecystitis among diabetic adults showed a non-significant rise from 1999 to 2002 (annual percentage changes [APC]: +8.6%), a significant decline from 2002 to 2015 (APC: –2.1%), followed by a significant rise from after 2015 (APC: +5.9%). Overall AAPC was +1.26% (P = 0.13). A total of 8,470 deaths were recorded. Racially, AAMR was highest in American Indian or Alaska Native (3.3), followed by Hispanic or Latino (2.9), Black or African American (2.7), Asian or Pacific Islander (1.8), and White (1.5). AAMRs increased for both genders; men had consistently higher rates, rising from 2.0 to 2.8, compared to 1.4 to 1.8 in women. Regionally, the highest rate was in the West (2.1), followed by the Midwest and South (1.7 each), and the Northeast (1.6). AAMRs increased in both metropolitan (1.7 to 2.2) and non-metropolitan areas (1.7 to 2.5), with a greater rise in the latter. Among middle-aged adults (45–64), AAMR increased from 0.7 to 1.2, with a significant post-2015 rise (APC: +9.24%, CI: 1.59-17.46). In older adults (≥65), AAMRs rose from 7.0 in 1999 to 8.1 in 2020, with an initial increase from 1999 to 2002 (APC: +8.79%, CI: –3.08 to 22.12), a significant decline from 2002 to 2015 (APC: –1.99%, CI: –3.14 to –0.83), and a significant rise from 2015 to 2020 (APC: +4.56%, CI: 0.69 to 8.58, P < 0.05). Conclusion: Rising cholecystitis-related mortality among diabetic adults, particularly among Hispanics, men, residents of the West and non-metropolitan areas, along with a post-2015 increase in mortality among middle-aged and older adults, underscores the importance of implementation of stratified public health policies and clinical protocols tailored to demographic and regional risk factors to reduce mortality and improve outcomes.