Critical shortage of gastrointestinal physician density in the USA: impact on mortality from upper gastrointestinal bleeding

Background Upper gastrointestinal bleeding (UGIB) continues to pose a significant burden on the national healthcare system. However, geographical patterns of UGIB-associated mortality have not been explored in depth. Therefore, we investigated trends of UGIB mortality in the United States and examined the impact of primary care provider density (PCPD) and gastrointestinal physician density (GIPD). Methods ICD-10 codes for UGIB mortality were identified using the CDC WONDER database. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) were extracted from the Multiple Cause of Death files covering 1999–2023 using the 2000 US Census as the standard population. Correlation and linear regression analyses were performed to evaluate Area Health Resource File (AHRF) study variables, including, but not limited to, PCPD and GIPD. Results The overall CMR for UGIB during the study period (1999–2023) was 12.1 per 100,000 population, whereas the AAMRs were 11.0 per 100,000 population in the United States. Overall mortality rates increased during the period 2018 to 2021 [annual percent change (APC): +9.05] and decreased from 2021 to 2023 (APC: −7.93). CMRs were highest among older age groups, American Indian or Alaska Native populations, and rural communities. Men had higher AAMRs than women. From 1999 to 2023, states that ranked in the top 90th percentile for overall CMRs included West Virginia, Rhode Island, Vermont, South Dakota, New Mexico, and Wyoming. According to data from AHRF, GIPD in the 50 states was significantly associated with CMRs, with the lowest quartiles of GIPD associated with the highest UGIB mortality [odds ratio (OR): 1.121, 95% confidence interval (1.090–1.153), p < 0.001]. In contrast, PCPD was not associated with CMRs ( p = 0.120). Conclusion GIPD, rather than PCPD, was significantly associated with higher CMRs for UGIB.