Temporal Trends in Acute Cholangitis Mortality Rates from 1999 to 2021: An Analysis Using the CDC WONDER Database

Introduction: Acute cholangitis presents as an acute biliary tract infection with potentially lethal outcomes. The primary objective of this study was to devise a reliable risk prediction model to aid physicians in categorizing patients with acute cholangitis into distinct treatment groups. Considering the widespread upheavals in healthcare services and the realignment of healthcare priorities amidst the COVID-19 pandemic, grasping its impacts on the handling and results of acute cholangitis could offer invaluable understanding. Methods: The study assessed mortality rate trends, leveraging data from the CDC WONDER database from 1999 to 2021. CDC WONDER, standing for Wide-ranging Online Data for Epidemiologic Research, was the main data repository employed for this research. This online platform, curated by the Centers for Disease Control and Prevention (CDC), provides public health professionals and the wider public easy access to an extensive range of public health data. For this study, the specific focus was on deaths resulting from acute cholangitis between 1999 and 2021, to scrutinize all such fatalities recorded in the United States during that timeframe. The analytical procedures and data visualizations were executed using R 4.2.2 software. The ggplot2 package was employed for the generation of all the graphical representations. Results: We analyzed data for 30,663 individuals who died from acute cholangitis from 1999 to 2021. We found that the overall mortality rate per 100,000 people increased from 0.41 in the pre-COVID period (1999-2018) to 0.54 during the COVID era (2019-2021), with the peak mortality rate observed in 2021 (0.58) and then 2020 (0.54). The average mortality rate for individuals above 85 years old was 9%, while 2.74% for those aged 74 to 85. Upon examining race, the mortality rate for Whites was higher (0.47) compared to the Black or African American population (0.30) (Figure 1, Table 1). Conclusion: This research aims to offer an essential understanding of the progression of this particular health concern during the unprecedented situation induced by the pandemic. By capitalizing on the vast dataset housed in the CDC WONDER database, this research intends to illuminate any potential links between the era of COVID-19 and the mortality rate associated with acute cholangitis.Figure 1.: Mortality rate across the US states (1999-2021). Table 1. - Mortality rate (1999-2021) Mortality Rate per 100,000 Pre COVID era During COVID era 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 deaths 971 1065 1108 1156 1171 1127 1207 1112 1166 1220 1240 1228 1314 1265 1309 1444 1434 1539 1581 1613 1679 1783 1931 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 0.35 0.38 0.39 0.40 0.40 0.38 0.41 0.37 0.39 0.40 0.40 0.40 0.42 0.40 0.41 0.45 0.45 0.48 0.49 0.49 0.51 0.54 0.58 Gender Male 0.32 0.35 0.35 0.38 0.38 0.37 0.39 0.34 0.36 0.37 0.37 0.38 0.40 0.39 0.40 0.45 0.43 0.46 0.45 0.47 0.50 0.52 0.55 Female 0.38 0.41 0.42 0.42 0.43 0.4 0.43 0.4 0.41 0.44 0.44 0.42 0.44 0.41 0.42 0.46 0.47 0.49 0.52 0.52 0.52 0.56 0.62 Race White 0.37 0.40 0.41 0.43 0.43 0.42 0.43 0.41 0.41 0.43 0.43 0.43 0.47 0.44 0.44 0.50 0.49 0.52 0.53 0.54 0.56 0.59 0.64 Black or African American 0.27 0.32 0.32 0.28 0.31 0.27 0.29 0.23 0.29 0.29 0.30 0.28 0.23 0.26 0.30 0.30 0.31 0.28 0.33 0.31 0.31 0.37 0.43 Asian or Pacific Islander 0.19 0.20 0.20 0.25 0.21 0.21 0.32 0.23 0.33 0.25 0.31 0.28 0.30 0.33 0.30 0.30 0.24 0.43 0.39 0.37 0.37 0.41 0.50 American Indian or Alaska Native - - - 0.31 - - - 0.27 0.26 - 0.24 0.26 0.23 0.23 0.47 - 0.26 0.37 0.26 0.25 0.36 0.49 0.44 Age data 25-34 years - - 0.03 0.04 0.03 - - 0.03 0.03 0.02 - - 0.03 0.03 - - 0.02 0.03 - - - 0.03 0.03 35-44 years 0.05 0.05 0.06 0.05 0.05 0.06 0.07 0.06 0.04 0.06 0.07 0.02 0.05 0.05 0.06 0.06 0.05 0.08 0.03 0.03 0.07 0.08 0.06 45-54 years 0.12 0.16 0.18 0.13 0.13 0.12 0.11 0.11 0.11 0.13 0.14 0.11 0.11 0.14 0.13 0.14 0.15 0.11 0.14 0.14 0.14 0.17 0.16 55-64 years 0.43 0.37 0.34 0.39 0.41 0.31 0.37 0.3 0.37 0.28 0.35 0.29 0.35 0.36 0.35 0.34 0.33 0.31 0.37 0.35 0.39 0.46 0.45 65-74 years 0.86 0.98 0.99 1.13 1.02 0.99 0.95 0.84 0.93 0.94 0.94 0.88 0.89 0.87 0.86 0.98 0.88 1.03 1.06 1.15 1.01 1.16 1.28 75-84 years 2.22 2.58 2.6 2.61 2.73 2.76 2.84 2.69 2.61 2.64 2.67 2.66 2.91 2.44 2.61 2.83 2.84 2.86 2.86 2.99 3.06 2.94 3.25 85+ years 8.43 8.85 9.16 9.41 9.29 8.62 9.35 8.26 8.45 9.24 8.51 9.1 8.87 8.34 8.43 8.99 8.89 9.53 9.23 8.71 9.17 9.12 11.2 Hispanic origin Hispanic or Latino 0.17 0.20 0.18 0.16 0.17 0.14 0.22 0.19 0.16 0.19 0.22 0.17 0.20 0.20 0.21 0.22 0.20 0.22 0.27 0.24 0.27 0.29 0.3 Not Hispanic or Latino 0.37 0.40 0.42 0.44 0.44 0.42 0.44 0.40 0.43 0.44 0.44 0.44 0.47 0.44 0.45 0.50 0.50 0.53 0.53 0.55 0.57 0.6 0.65