Examining Trends in Mortality Rates Linked to Spontaneous Bacterial Peritonitis in the United States: A Comparative Study Before and After the Emergence of COVID-19

Introduction: The escalating burden of liver diseases and their associated complications, such as Spontaneous Bacterial Peritonitis (SBP), remains a significant public health challenge in the United States. SBP has consistently attracted attention due to its high mortality rate. Understanding and assessing trends in mortality rates related to SBP is paramount to targeting interventions, allocating resources, and informing healthcare policies. In this context, our research seeks to evaluate patterns in mortality rates associated with Spontaneous Bacterial Peritonitis in the United States, comparing trends before and after the outbreak of COVID-19. Methods: This study utilized the CDC WONDER database to analyze mortality rate trends from 1999 to 2021, with a particular emphasis on deaths due to Spontaneous Bacterial Peritonitis (SBP). The study specifically focused on scrutinizing all recorded fatalities linked to SBP in the United States within this period. R 4.2.2 software was the primary tool for conducting the analytical processes and creating data visualizations. Results: We obtained data from 35992 death of SBP between 1999 and 2021 using the CDC WONDER underlying cause of death database. The overall mortality rate from SBP trended from 0.57 per 100,000 in 1999 to 0.56 per 100,000 in 2021. The highest mortality rate was recorded in 2000 (0.59), followed by 1999 (0.57), respectively. Based on race classification, the white race recorded an average mortality rate of 0.53 compared with the black or African American rate of 0.50. When stratified by gender, both male and female populations experienced a rise in mortality rates over time. However, female mortality rates were consistently higher, at 0.61 per 100,000 in 1999 and reaching 0.57 per 100,000 in 2021. Conversely, male mortality rates were from 0.54 per 100,000 in 1999 to 0.55 per 100,000 in 2021. Conclusion: The COVID-19 pandemic could directly affect the mortality rate from Spontaneous Bacterial Peritonitis (SBP) by delaying diagnosis and treatment due to pandemic-related fear. Overwhelmed healthcare systems might compromise the quality of care for SBP patients. Our study aims to illuminate the influence of the pandemic on SBP-related outcomes, offering a comprehensive understanding of the trajectory of this liver disease complication in the COVID-19 era (Table 1). Table 1. - Trending the SBP mortality rate from 1999-2021 using CDC Wonder database Mortality rate per 100,000 Variables 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Total number of death 1597 1661 1562 1590 1531 1476 1504 1434 1512 1505 1438 1442 1490 1483 1554 1619 1589 1619 1604 1641 1570 1708 1863 Total Population 279M 281M 285M 288M 290M 293M 296M 298M 301M 304M 307M 309M 312M 314M 316M 319M 321M 323M 326M 327M 328M 329M 332M Mortality rate Overall mortality rate 0.57 0.59 0.55 0.55 0.53 0.5 0.51 0.48 0.5 0.49 0.47 0.47 0.48 0.47 0.49 0.51 0.49 0.5 0.49 0.5 0.48 0.52 0.56 Gender Male 0.54 0.52 0.48 0.44 0.48 0.45 0.44 0.41 0.46 0.46 0.43 0.44 0.43 0.45 0.47 0.49 0.47 0.5 0.47 0.48 0.49 0.51 0.55 Female 0.61 0.66 0.61 0.66 0.57 0.56 0.58 0.55 0.54 0.53 0.51 0.49 0.52 0.5 0.51 0.53 0.52 0.5 0.51 0.52 0.47 0.52 0.57 Age data 25-34 years 0.06 0.06 0.04 0.05 0.05 0.04 0.05 0.05 0.04 0.04 0.04 0.05 0.06 0.06 0.04 0.03 0.05 0.03 0.05 0.06 0.03 0.06 0.04 35-44 years 0.17 0.18 0.15 0.13 0.13 0.15 0.1 0.13 0.12 0.12 0.11 0.09 0.11 0.09 0.11 0.13 0.12 0.12 0.15 0.15 0.11 0.16 0.22 45-54 years 0.38 0.37 0.37 0.36 0.37 0.32 0.35 0.33 0.3 0.32 0.36 0.34 0.38 0.31 0.3 0.38 0.36 0.39 0.32 0.36 0.32 0.43 0.47 55-64 years 0.79 0.92 0.65 0.69 0.64 0.62 0.71 0.56 0.71 0.72 0.72 0.73 0.61 0.84 0.78 0.74 0.81 0.8 0.8 0.83 0.79 0.81 0.87 65-74 years 1.75 1.72 1.56 1.48 1.54 1.41 1.44 1.46 1.35 1.43 1.23 1.28 1.35 1.15 1.31 1.42 1.33 1.37 1.34 1.32 1.27 1.35 1.5 75-84 years 3.8 3.73 3.72 3.89 3.44 3.32 3.19 2.97 3.35 2.99 2.93 2.86 2.72 2.72 2.77 2.85 2.49 2.51 2.41 2.36 2.41 2.34 2.55 85+ years 8.59 9.32 9.32 9 8.24 7.92 7.69 7.03 7.1 6.56 5.5 5.46 6.07 5.16 5.55 4.92 4.69 4.58 4.37 4.1 3.8 3.93 4.42 Mortality rate per 100,000 Variables 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Total number of death 1597 1661 1562 1590 1531 1476 1504 1434 1512 1505 1438 1442 1490 1483 1554 1619 1589 1619 1604 1641 1570 1708 1863 Total Population 279M 281M 285M 288M 290M 293M 296M 298M 301M 304M 307M 309M 312M 314M 316M 319M 321M 323M 326M 327M 328M 329M 332M Mortality rate Overall mortality rate 0.57 0.59 0.55 0.55 0.53 0.5 0.51 0.48 0.5 0.49 0.47 0.47 0.48 0.47 0.49 0.51 0.49 0.5 0.49 0.5 0.48 0.52 0.56 Race White 0.58 0.59 0.56 0.58 0.54 0.53 0.53 0.51 0.52 0.52 0.49 0.5 0.52 0.5 0.52 0.55 0.53 0.53 0.54 0.52 0.53 0.54 0.6 Black or African American 0.66 0.72 0.57 0.56 0.57 0.51 0.51 0.42 0.54 0.51 0.49 0.41 0.43 0.43 0.47 0.44 0.46 0.47 0.38 0.54 0.38 0.53 0.55 Asian or Pacific Islander 0.22 0.17 0.24 0.19 0.16 0.17 0.15 0.15 0.15 0.16 0.2 0.13 0.11 0.2 0.16 0.2 0.17 0.19 0.13 0.2 0.16 0.23 0.25 American Indian or Alaska Native - 0.44 - - 0.3 0.35 - - 0.37 0.38 0.29 0.28 - 0.34 0.29 0.4 0.31 0.41 0.47 0.59 - 0.51 0.71 Hispanic origin Hispanic or Latino 0.24 0.22 0.19 0.13 0.26 0.2 0.17 0.18 0.22 0.19 0.19 0.2 0.21 0.21 0.2 0.23 0.22 0.22 0.27 0.24 0.21 0.29 0.26 Not Hispanic or Latino 0.62 0.64 0.6 0.62 0.57 0.55 0.57 0.53 0.55 0.55 0.52 0.52 0.53 0.52 0.55 0.57 0.55 0.56 0.54 0.56 0.54 0.57 0.63