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

## TL;DR

This study examines mortality trends from colorectal diseases in the U.S. from 1999 to 2020, finding that while cancer deaths declined, deaths from benign conditions remained stable.

## Contribution

The study provides the first comprehensive analysis of population-level mortality trends for benign colorectal conditions in the U.S.

## Key findings

- Colorectal cancer mortality decreased significantly over the study period.
- Mortality from benign colorectal conditions remained stable despite advances in cancer prevention.
- Clostridioides difficile enterocolitis was the leading cause of death among benign colorectal conditions.

## Abstract

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.

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).

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.

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.