TEMPORAL TREND OF EXCESS INTRA-ABDOMINAL INFECTIONS-RELATED DEATHS AND RACIAL/ETHNIC DISPARITIES BEFORE AND DURING THE COVID-19 PANDEMIC
Yi Liu*1, Yee Hui Yeo3, Jamil S. Samaan3, Youssef Essanaa4, Fan Lv2, Xinyuan He1, Zixuan Xing1, Sikai Qiu6, Yunyu Zhao1, Kamran Samakar5, Fanpu Ji1
1Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; 2Xi'an Jiaotong University School of Mathematics and Statistics, Xi'an, Shaanxi, China; 3Cedars-Sinai Medical Center, Los Angeles, CA; 4University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA; 5University of Southern California Keck School of Medicine, Los Angeles, CA; 6Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China
Background
Intra-abdominal infections have a high morbidity and mortality rate and require early diagnosis and management. The COVID-19 pandemic makes care disruptions and delayed presentation an important concern. Little is known about the disparity in excess mortality and racial/ethnic disparities in intra-abdominal infections-related mortality before and during the pandemic through September 2022.
Methods
Death records among Americans aged ≥25 years were obtained from the National Vital Statistics System (NVSS), which reports over 99% of deaths in the United States. Using ICD-10 codes, intra-abdominal infections were defined as acute cholecystitis, acute appendicitis, C. difficile colitis, diverticulitis, and pyelonephritis. We calculated age-standardized mortality rates (ASMR) (per 100,000 population) and years of potential life lost (YPLL) from 1999 to 2021. Predicted ASMRs and YPLLs during the pandemic based on the observed trend from 1999 to 2019 were estimated. Excess death was defined as the percentage difference between the observed and the predicted values. Joinpoint analysis was used to calculate annual percentage change (APC). Monthly ASMR was updated through September 2022.
Results
From 1999 to 2021, there were 469,655 intra-abdominal infections-related deaths. Of these, 82.4% were Whites, followed by Blacks (8.6%), Hispanics (6.32%), Asians/Pacific Islanders (2.06%), and American Indians/Alaska Natives (0.59%). The overall intra-abdominal infections-related ASMR increased from 2001 to 2006 (APC 6.9, P<0.001), followed by a decreasing trend from 2006 to 2015 (APC -0.8, P<0.05), and sharply decreased to 8.38 in 2019 (APC -5.3, P<0.01). During the pandemic, ASMR rose to 8.64 in 2020 and 9.23 in 2021, leading to excess mortality of 10.6% in 2020 and 29.4% in 2021. (Table 1) Excess mortality was observed across all racial/ethnic groups in 2020, with Hispanics having the highest excess mortality rates, followed by Whites, while Blacks had the lowest. Focusing on deaths below the age of 65, significant racial/ethnic disparities in excess YPLLs, with Hispanics showing the greatest excess YPLL and Whites experiencing the lowest. Furthermore, the monthly trend of ASMR updated through 9/2022 showed persistent excess death, with peaked ASMR occurring in 1/2022 and no significant difference in the decreasing trends between 1-9/2021 and 1-9/2022. Notably, the gaps between predicted and observed ASMR in both Blacks and Whites widened in 2022 when compared to 2021.
Conclusions
We observed a large increase in intra-abdominal infections-related death during the pandemic in the U.S. Both ASMR and YPLL increased across all racial/ethnic groups but also widened existing disparities during the COVID-19 pandemic. Hispanics with intra-abdominal infections experienced a disproportionate excess death compared to Whites and Blacks.
Table 1. All-cause age-standardized mortality rate (ASMR) in adults (≥25 years) and years of potential life lost (YPLL) from premature deaths (<65 years) attributable to Intra-abdominal infections per 100,000 persons in the United States overall and by race/ethnicity, 1999-2021
Figure 1. All-cause age-standardized mortality rate (ASMR) in adults (≥25 years) and years of potential life lost (YPLL) from premature deaths (<65 years) attributable to Intra-abdominal infections per 100,000 persons in the United States overall between 1/2018 and 9/2022 by monthly
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