Trends in urinary tract infection-related mortality among older adults with dementia in the United States: A population-based observational study using CDC WONDER (1999-2020).

Dementia is a major cause of morbidity and mortality among older adults, and urinary tract infections (UTIs) are frequent, clinically significant complications in this population. However, there is limited national evidence describing mortality trends where UTI is listed as the underlying cause of death among individuals with dementia in the United States. We conducted a population-based descriptive study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause-of-Death database (1999-2020). Deaths were identified using International Classification of Diseases, 10th Revision codes for UTI (N39.0) as the underlying cause and unspecified dementia (F03) as a multiple cause. We computed crude and age-adjusted mortality rates (AAMR) per 100,000, standardized to the 2000 US population. Temporal trends were assessed using joinpoint regression to estimate annual percent change and 95% confidence intervals (CIs), stratified by sex, age, race/ethnicity, region, and urbanization. Between 1999 and 2020, 125,797 deaths were attributed to UTI with comorbid unspecified dementia. The national AAMR increased from 18.20 to 26.30 per 100,000, with a non-significant annual percent change (-0.44%, 95% confidence interval = -1.38 to 0.51), suggesting no consistent annual increase. Mortality increased similarly in both sexes, but the absolute burden was higher in women. The highest mortality occurred among adults aged ≥75 years. Non-Hispanic White individuals accounted for most deaths and showed a 51.1% increase in AAMR. The greatest state-level rates were observed in South Carolina, North Carolina, West Virginia, Oklahoma, and Tennessee, while the lowest were in Arizona, Nevada, and Hawaii. Nonmetropolitan areas consistently experienced higher mortality. Mortality due to UTI as the underlying cause of death among older adults with dementia remained stable in the United States from 1999 to 2020, with notable geographic and demographic disparities. Women, non-Hispanic Whites, older adults, and rural residents carried the highest burden. These findings highlight the urgent need for improved infection prevention, timely diagnosis of atypical UTI presentations, and equitable access to healthcare for dementia patients, particularly in high-risk and rural regions.