Mortality trends from colorectal pathologies in the United States (1999-2020): a retrospective cohort study using CDC WONDER.

[BACKGROUND] Colorectal diseases encompass both malignant and benign conditions with significant public health implications. While colorectal cancer (CRC) mortality has been well characterized, population-level mortality trends for benign colorectal conditions remain poorly defined.

[METHODS] This retrospective cohort study analyzed mortality data for U.S. decedents aged ≥15 years from 1999-2020 using the CDC WONDER database. Underlying causes of death were categorized as CRC, inflammatory bowel disease (IBD), or benign colorectal conditions. Crude death rates (CDRs) per million were calculated, and temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC).

[RESULTS] Of 56,014,102 total deaths, 1,560,448 (2.7%) were due to colorectal pathologies. CRC accounted for most deaths (CDR 216.2), followed by benign colorectal conditions (68.5) and IBD (3.8) (p0.001). Among benign causes, Clostridioides difficile enterocolitis (CDR 21.6) was the leading contributor, followed by diverticular disease (12.4) and acute vascular intestinal disorders (9.0). CRC mortality declined significantly (AAPC -1.44%, p0.05), whereas benign colorectal and IBD mortality remained stable.

[CONCLUSIONS] Mortality from benign colorectal conditions has persisted over two decades despite major declines in CRC mortality, highlighting unmet needs in research and prevention. Future public health efforts should extend beyond malignancy to address preventable deaths from benign colorectal disease.