System-level opportunities to reduce mortality in intestinal obstruction: US trends, 1999-2023

Intestinal obstruction is among the most common surgical emergencies worldwide, yet contemporary, population-level mortality patterns in the United States, especially across demographic and geographic strata, remain incompletely defined.

We used National Vital Statistics System death certificates, accessed via Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (1999-2023), to identify United States deaths among persons aged 35 years or older with intestinal obstruction as the underlying cause. Age-adjusted mortality rates per 100,000 were computed by direct standardization to the 2000 United States standard population. Joinpoint regression estimated annual percent change and average annual percent change overall and within strata of sex, age, race/ethnicity, census region, and 2013 National Center for Health Statistics urbanization categories.

Among persons aged 35 years or older, 153,472 deaths occurred nationally from 1999 to 2023; annual deaths rose from 4,926 to 7,860. The overall age-adjusted mortality rate shifted from 3.56 to 3.68 per 100,000, with a prolonged decline followed by renewed increases beginning in the late 2010s, intensified in 2018-2023, and accelerating during 2020-2023. Recent upturns were most pronounced among middle-aged and older adults, as well as non-Hispanic White and Black populations, in the Northeast and South, and in nonmetropolitan areas. Subtypes showed sharp increases for paralytic ileus; modest rises for ileus unspecified and other/unspecified obstruction; a long-term decline for adhesions; and a mid-2010s upturn for volvulus.

United States mortality from intestinal obstruction displays a biphasic pattern with recent upturns coinciding with the pandemic period, superimposed on demographic, geographic, and subtype heterogeneity. Findings support the importance of targeted early recognition, streamlined transfer pathways, and resilient emergency surgical capacity for high-risk groups.