Demographic and geographic disparities in adult intestinal infectious disease mortality in the United States from 1999 to 2023

Intestinal infectious diseases (IID) pose significant health and financial burdens in the United States (US). This study analyzes demographic and geographic disparities in IID-associated mortality among US adults from 1999 to 2023. Retrospective data from the CDC WONDER database (1999–2023) were analyzed for decedents aged ≥ 25 years listing IID as an underlying or contributing cause of death. Age-adjusted mortality rates (AAMR) per 1,000,000 were calculated across sex, race/ethnicity, age, urbanization, and state (geographic analyses restricted to 1999–2020). Joinpoint regression estimated Annual Percent Changes (APC). Among 294,178 IID-associated deaths, AAMRs surged significantly from 1999 to 2005 (APC 28.07; p < 0.05) and 2005–2011 (APC 9.88; p < 0.05), followed by a decline through 2023 (APC − 4.94; p < 0.05). Males had higher mean AAMRs than females (54.3 vs. 52.7). Non-Hispanic (NH) Whites (54.3) and small/medium metropolitan areas (54.4) recorded the highest AAMRs among racial and geographic subgroups. US IID-associated mortality increased until 2011 before declining. Persistent disparities with the highest mortality burden among men, NH Whites, and residents of small/medium metropolitan areas highlight the need for targeted public health interventions.