CDC-WONDER database analysis of external causes of mortality and morbidity in the United States

External causes of mortality, such as accidents, suicide, and homicide, remain a significant public health concern in the United States. Although previous studies have examined injury-related mortality in specific populations or over shorter timeframes, comprehensive analyses of long-term national trends across demographic subgroups are limited. This study analyzed trends in external cause-related deaths and age-adjusted mortality rates (AAMR) in the U.S. (1999–2023) and subgroup differences to improve the understanding of long-term patterns and identify populations that may benefit from future targeted interventions. Data were extracted from the CDC WONDER Database. Key indicators included death counts, percent change in deaths, AAMR (with 95% confidence interval CI), and average annual percent change (AAPC, with 95% CI). Stratified analyses were performed by sex, census region, race/ethnicity, urbanization level, and age group. The Joinpoint Regression Program was used to determine trends in mortality within the study period. Joinpoint regression analysis was employed to determine annual percentage changes (APCs) and assess statistical significance ( P < .05). A total of 1,234,567 external cause deaths were recorded between 1999 and 2023, with males accounting for approximately 73% of all deaths. Total external cause deaths rose by 5.77% (1999: 29,642; 2023: 31,353), while AAMR slightly declined (1999: 30.08 29.73–30.42; 2023: 28.85 28.53–29.17) with a non-significant AAPC (0.13 −0.96–1.23). Male deaths rose more (6.33%) than females (4.19%), with higher male AAMR (both AAPCs non-significant). Deaths fell in the Northeast (−16.22%) and Midwest (−4.32%), rose in the South (16.00%) and West (9.80%); only the Northeast had significant downward AAMR (AAPC: −0.55 −0.88–−0.21, P < .05). Deaths increased most in non-Hispanic (NH) Other (84.54%) and Hispanic (65.83%) groups, fell in NH White (−23.58%); NH Black AAMR rose (1999: 46.30; 2023: 57.45, AAPC non-significant). The “NH Other” category includes individuals identifying as American Indian or Alaska Native, Asian, Native Hawaiian, or Other Pacific Islander, as classified by the CDC WONDER database. Metropolitan deaths rose (15.37%), non-metropolitan deaths fell (−28.34%); non-metropolitan areas had significant downward AAMR (AAPC: −0.67 −1.26–−0.07, P < .05). Deaths rose in infants aged < 1 year (30.87%) and individuals aged 15 to 24 years (14.43%), fell in children aged 1 to 4 years (−32.14%) and children aged 5 to 14 years (−31.30%); the 1 to 4 and 5 to 14 years age groups had significant downward crude mortality (AAPCs: −1.15, −1.50, P < .05). Total U.S. external cause deaths slightly increased, with stable overall AAMR, but significant subgroup differences highlight the need for targeted interventions.