Temporal trends and demographic disparities in mortality from paralytic ileus and intestinal obstruction among U.S. adults aged 55 and older, 1999–2023: a retrospective analysis

Paralytic ileus and intestinal obstruction (PIAIO) severely strain healthcare systems, yet the long-term mortality trends and demographic disparities among U.S. adults aged 55 and older are insufficiently examined. This study aimed to investigate temporal variations in PIAIO-related mortalities across subgroups categorized by sex, age, ethnicity, and geographic region. We conducted a retrospective study using death certificate data from the CDC WONDER database (1999–2023), including U.S. adults aged 55 years and older for whom an ICD-10 code within K56 was recorded as the underlying cause of death. Age-adjusted mortality rates (AAMRs) were computed based on the 2000 U.S. census population. We utilized joinpoint regression modeling to quantify annual fluctuations in mortality trends, calculating both annual percentage changes (APCs) and average annual percentage changes (AAPCs). A total of 147,214 deaths related to PIAIO were documented (89,594 females; 57,620 males). Joinpoint analysis revealed that although the overall AAMR remained statistically stable from 1999 to 2023 (AAPC 0.14, 95% CI: -0.24 to 0.52; p = 0.47), the temporal trend was characterized by a significant decline between 2002 and 2018 (APC − 1.02, 95% CI: -1.22 to -0.82, p < 0.001), which was reversed by a sharp increase from 2018 to 2023 (APC 2.95, 95% CI: 1.96 to 3.95; p < 0.001). Descriptive analysis indicated that Non-Hispanic (NH) Black individuals and non-metropolitan residents exhibited the highest observed mortality burden. Notably, adults aged 55–64 years showed a significant sustained increase in mortality from 1999 to 2023 (AAPC 2.16, p < 0.001). Recent mortality rises were also observed in the Northeast, South, and West regions. While PIAIO-related mortality remained overall stable since 1999, the significant post-2018 increase and persistent demographic disparities are concerning. Targeted public health strategies may be warranted for high-risk groups, particularly rural and racial minority populations.