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Background <p>Peptic ulcer disease (PUD) remains a cause of gastrointestinal mortality despite advances in Helicobacter pylori eradication and gastroprotection.</p> Methods <p>We analyzed U.S. death certificates in CDC WONDER from 1999 to 2023, using Underlying Cause-of-Death files. Age-adjusted mortality rates (AAMRs; per 100,000) were standardized to the 2000 U.S. population. Trends used average annual percent change (AAPC). Analyses were stratified by sex, age, race/ethnicity, region, urban–rural status, and ICD-10 subtype (K25–K28).</p> Results <p>From 1999 to 2023, there were 87,574 PUD deaths. Annual deaths fell from 4,575 (1999) to 3,850 (2023; − 15.85%). AAMR declined from 3.30 (95% CI 3.20–3.39) to 1.78 (1.73–1.84) (AAPC − 2.66%, 95% CI − 3.80 to − 1.51). In 2023, AAMR was 2.09 (2.00–2.19) in males and 1.46 (1.39–1.52) in females; rates rose with age from 0.25 (35–44&#xa0;years) to 14.71 (≥ 85&#xa0;years). By race/ethnicity, AAMR was 1.81 (non-Hispanic [NH] White), 1.70 (NH Black), 1.57 (NH Other), and 1.47 (Hispanic). The West reached its highest point in 1999 and 2023. By 2013, NCHS (through 2020), the metropolitan AAMR was 1.74 (1.67–1.80) compared to 2.07 (1.91–2.23) in nonmetropolitan areas. Duodenal and gastric ulcers predominated; subtype AAPCs showed the steepest decline for unspecified-site ulcers.</p> Conclusions <p>PUD mortality declined over a 25-year period but plateaued or increased in selected strata in the late 2010s and during the pandemic. Findings support sustained H. pylori control, evidence-based gastroprotection for high-risk medication users, and timely endoscopy—especially for older adults, men, rural residents, and regions with a high burden. Continuous surveillance should monitor post-pandemic rebound risks and equity in access.</p>

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Trends and inequities in peptic ulcer mortality across the United States, 1999–2023

  • 期刊论文

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  • 发表日期：

    2026年2月12日

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  • Xiaoming Lin,
  • Shuai Wang,
  • Yunan Guan,
  • Helei Wang

摘要

Background

Peptic ulcer disease (PUD) remains a cause of gastrointestinal mortality despite advances in Helicobacter pylori eradication and gastroprotection.

Methods

We analyzed U.S. death certificates in CDC WONDER from 1999 to 2023, using Underlying Cause-of-Death files. Age-adjusted mortality rates (AAMRs; per 100,000) were standardized to the 2000 U.S. population. Trends used average annual percent change (AAPC). Analyses were stratified by sex, age, race/ethnicity, region, urban–rural status, and ICD-10 subtype (K25–K28).

Results

From 1999 to 2023, there were 87,574 PUD deaths. Annual deaths fell from 4,575 (1999) to 3,850 (2023; − 15.85%). AAMR declined from 3.30 (95% CI 3.20–3.39) to 1.78 (1.73–1.84) (AAPC − 2.66%, 95% CI − 3.80 to − 1.51). In 2023, AAMR was 2.09 (2.00–2.19) in males and 1.46 (1.39–1.52) in females; rates rose with age from 0.25 (35–44 years) to 14.71 (≥ 85 years). By race/ethnicity, AAMR was 1.81 (non-Hispanic [NH] White), 1.70 (NH Black), 1.57 (NH Other), and 1.47 (Hispanic). The West reached its highest point in 1999 and 2023. By 2013, NCHS (through 2020), the metropolitan AAMR was 1.74 (1.67–1.80) compared to 2.07 (1.91–2.23) in nonmetropolitan areas. Duodenal and gastric ulcers predominated; subtype AAPCs showed the steepest decline for unspecified-site ulcers.

Conclusions

PUD mortality declined over a 25-year period but plateaued or increased in selected strata in the late 2010s and during the pandemic. Findings support sustained H. pylori control, evidence-based gastroprotection for high-risk medication users, and timely endoscopy—especially for older adults, men, rural residents, and regions with a high burden. Continuous surveillance should monitor post-pandemic rebound risks and equity in access.