Temporal trends and demographic disparities in constipation-associated mortality in the United States, 1999–2024

Abstract

Constipation is common and managed as benign; however, refractory disease can progress through fecal impaction to stercoral colitis, perforation, and sepsis. The national mortality trends are unmapped. Serial cross-sectional CDC WONDER multiple-cause analysis, US adults ≥ 25 years, 1999–2024 (final; 2025 provisional, secondary). Cases with ICD-10 K59.0 anywhere on the certificate were included. Age-adjusted mortality rates (AAMRs) were modelled using joinpoint regression with year-by-group interaction tests. Multiple versus underlying cause mortality and dementia and complication co-coding were quantified. Of 22,237 deaths, the AAMR rose from 0.26 (95% CI 0.23–0.28) to 0.55 (0.53–0.58); AAPC 2.68 (2.10–3.26) stable to 2012 (APC 0.67, P = 0.149), then rising (APC 4.90, P < 0.001). Constipation was a contributing cause, a median of 5.66-fold more often than the underlying cause, widening by 1.68% annually ( P < 0.001). Rates rose among women (0.28→0.57; AAPC 2.93) and men (0.24→0.54; AAPC 3.42), faster in men (interaction P = 0.008); at ages ≥ 65 (1.25→2.28; AAPC 2.16) and 45–64 (0.04→0.18; AAPC 5.15); and among non-Hispanic White (0.27→0.61; AAPC 3.40) and non-Hispanic Black adults (0.25→0.56; AAPC 2.91), without differential trend ( P = 0.782); all AAPCs P < 0.001. Institutional settings accounted for 75.4% of deaths; dementia was co-coded in 23.4% and downstream complications in 37.4%. Psychoactive co-coding did not follow this trend. Constipation-associated mortality rose steadily, particularly among older adults and those in institutions. The contributing-cause pattern indicates that the underlying cause statistics substantially understate the toll. Protocolized bowel care in high-risk settings is warranted.