Trends and disparities in peptic ulcer disease mortality among U.S. adults, 1999–2023

Background: Peptic ulcer disease (PUD) incidence and mortality have declined in recent decades due to advances like Helicobacter pylori eradication, but PUD remains a significant health burden. We aimed to analyze national trends in PUD mortality from 1999 to 2023 among U.S. adults ≥35 years and identify demographic and geographic disparities. Methods: We analyzed death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging On-Line Data for Epidemiologic Research (1999–2023) for U.S. adult (≥35 years) deaths with PUD (ICD-10 K25–K27) as the underlying cause. Age-adjusted mortality rates (AAMRs per 100 000; standardized to the 2000 U.S. population) were calculated overall and by sex, age, race/ethnicity, region, and urban–rural classification. Joinpoint regression assessed trends and annual percent change (APC). Results: AAMR declined from 3.28 in 1999 to 1.73 in 2023 (average annual percent change (AAPC) : −2.66), with 86 504 PUD deaths recorded over this period. The decline was steepest during 1999–2010, then plateaued with a slight uptick after 2015. Men consistently had higher mortality than women (AAMR: 2.34 vs 1.69). AAMR increased sharply with age (0.21 in ages 35–44 vs 18.83 in ≥85). Non-Hispanic White adults had the highest mortality, and Hispanic adults the lowest. The West had the highest mortality rate and the Northeast the lowest. Nonmetropolitan areas had higher mortality than metropolitan areas. Conclusions: Despite a substantial decline in PUD mortality since 1999, progress plateaued in the 2010s and has recently reversed in some groups. Significant demographic and geographic disparities persist, emphasizing the necessity of targeted interventions to reach high-risk populations.