National trends in mortality involving acute pyelonephritis and obstructiveand reflux uropathy in the United States, 1999–2023

We conducted a descriptive serial cross-sectional analysis of U.S. CDC WONDER multiple-cause-of-death data from 1999–2023 to characterize mortality involving acute pyelonephritis and obstructive and reflux uropathy. Deaths were identified by mention of the condition on the death certificate; overall, sex-specific, and race- and ethnicity-specific analyses used age-adjusted mortality rates, whereas age-stratified analyses used age-specific mortality rates. Mortality involving acute pyelonephritis shifted in 2013, declining during 1999–2013 (APC, -2.0364%) and increasing during 2013–2023 (APC, 8.0056%). Mortality involving obstructive and reflux uropathy shifted in 2012, declining during 1999–2012 (APC, -1.4189%) and increasing during 2012–2023 (APC, 6.6420%). Higher estimated AAPCs during 2020–2023 than during 1999–2019 were observed across several sex, age, and race and ethnicity subgroups. In the exploratory combined endpoint, 80,676 death certificates mentioned either condition. These descriptive findings support continued surveillance and timely access to acute genitourinary care.