Nationwide age-adjusted trends and inequities in vascular intestinal disorder mortality in the United States, 1999 to 2023.

Vascular intestinal disorders (VID), including acute mesenteric ischemia and related intestinal vascular insufficiency syndromes, are rare but highly lethal causes of abdominal emergency mortality. National trends in VID mortality, and whether improvements have been equitable across demographic and geographic groups, have not been characterized through 2023. We conducted a nationwide ecological analysis of VID mortality in the United States from 1999 to 2023 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. We included adults aged 25 years or older when VID was listed as the underlying cause of death. For each year, we extracted the national death count and the age-adjusted mortality rate (per 1,00,000 population) and evaluated temporal change. From 1999 to 2023, 2,03,870 VID deaths occurred. Annual deaths declined from 8711 in 1999 to 7676 in 2023. Over the same period, the national age-adjusted mortality rate decreased from 4.93 to 2.75/1,00,000, corresponding to an average annual percent change of -2.41%. Deaths were concentrated in older adults: individuals aged 75 to 84 years accounted for 66,509 deaths (32.6% of all VID deaths), and those aged 85 years or older accounted for 59,009 deaths (28.9%). Females accounted for 1,30,125 cumulative VID deaths and males for 73,745. Nonmetropolitan counties and Southern regions carried a disproportionate share of deaths. Although VID mortality declined on an age adjusted basis, the absolute burden remains greatest in the oldest adults and in structurally disadvantaged settings, indicating persistent geographic and demographic inequity during and beyond the COVID-19 era.