Urinary Tract Infection-Related Mortality Trends in Adults Aged ≥ 25 Years in the United States: A CDC WONDER Analysis from 1999 to 2023

Background Urinary tract infections (UTI) are prevalent among adults in the United States, yet their demographic and regional mortality trends are unexplored. Uncovering national trends in UTI-related mortality among adults can highlight demographic and regional disparities, guiding research efforts aimed at improving clinical care and promoting better patient outcomes. This descriptive analysis reveals mortality trends and disparities among U.S. adults aged ≥ 25 years with UTI from 1999 to 2023. Methods The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause-of-Death dataset (1999–2023) was analyzed for mortality trends in adults aged ≥ 25 years using ICD-10 codes for UTI. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 were extracted by year, sex/gender, age, race/ethnicity, census region, state, and urban–rural divisions. Annual percent change (APC) and average annual percent change (AAPC) in AAMRs were calculated using the permutation test and the parametric method via Jointpoint regression software with corresponding 95% confidence intervals (95% CI). Results A total of 1,037,471 UTI-related deaths occurred among U.S. adults from 1999 to 2023, mainly in medical facilities (61.82%). Initially, AAMRs decreased from 20.04 in 1999 to 16.86 in 2018 (APC: -0.77; 95% CI: -1.21 to -0.45), followed by increasing rates until 19.38 in 2023 (APC: 3.57; 95% CI: 1.57 to 8.02). The highest mortality burden in terms of average AAMR was noted among older adults, women, non-Hispanic (NH) Black/African Americans, residents of the Southern census region, Tennessee, Oklahoma, and those in rural areas. Leading causes of death among UTI decedents shifted during the COVID-19 pandemic, with COVID-19 emerging as a major contributing cause. Conclusion UTI-related mortality among U.S. adults aged ≥ 25 years showed shifting trends and marked demographic and regional disparities. Older adults, women, NH Black/African Americans, rural residents, and those in the Southern Regions and States bore the greatest burden. Leading causes of UTI-associated deaths shifted during the pandemic, with COVID-19 emerging as a significant factor. These findings illustrate the urgency for targeted interventions and informed healthcare policies to address UTI-related mortality burden, especially in at-risk communities.