National Trends in Mortality From Upper Gastrointestinal Bleeding in the United States: Disparities and Implications for Emergency Endoscopic Access.

Introduction Upper gastrointestinal bleeding (UGIB) remains a significant cause of emergency department visits and hospitalizations across the United States. Despite advances in diagnostic and therapeutic modalities, mortality rates from UGIB continue to show marked variation across racial and geographic lines. Timely access to emergency endoscopic intervention is a critical determinant of outcomes, yet disparities in healthcare access and delivery may contribute to differential mortality. Methods We conducted a retrospective cross-sectional analysis using mortality data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database spanning 2018 to 2023. Data were stratified by state, race, and demographic subgroup. The analysis encompassed 60 state-race combinations across 51 states, totaling a population of 522,663,547 individuals from three racial groups: White, Black/African American, and Asian. Primary outcomes included total UGIB-related deaths and population-adjusted crude mortality rates, expressed as deaths per 100,000 population. States were grouped into US Census Bureau-defined regions for geographic analysis. We calculated both weighted and unweighted mean mortality rates and assessed disparities using population-adjusted mortality ratios. Results A total of 133,477 UGIB-related deaths were identified, yielding a national crude mortality rate of 25.54 per 100,000 population. Racial disparities were significant, with Black/African American populations exhibiting the highest mortality rate at 46.22 per 100,000 (mortality ratio 1.86 compared to White populations, 95% CI: 1.82-1.90). White populations showed a mortality rate of 24.89 per 100,000, while Asian populations had a rate of 29.15 per 100,000. Geographic variation was notable, with mortality among White populations ranging from 22.07 per 100,000 in California to 158.79 per 100,000 in Maine. Regional analysis revealed that the West had the lowest overall mortality rate at 21.27 per 100,000, while the Midwest demonstrated the most pronounced racial disparities, with mortality rates of 67.85 per 100,000 among Black populations and 27.65 per 100,000 among Whites. Conclusion Substantial racial and geographic disparities exist in UGIB-related mortality across the United States. Black Americans face nearly double the mortality risk of White Americans, and a greater-than-seven-fold variation in state-level mortality among White populations underscores systemic differences in emergency endoscopic access and care quality. These findings support the urgent need for targeted policy and health system interventions to improve timely access to emergency endoscopic services, especially in high-mortality regions and underserved racial communities.