Addressing Disparities in Osteomyelitis: The WONDER Project

Introduction Osteomyelitis, an infection of the bone and bone marrow, causes substantial morbidity and mortality, particularly in older adults and those with comorbidities such as diabetes and peripheral vascular disease. This study examines national trends in osteomyelitis mortality from 1999–2023 using CDC WONDER. Despite therapeutic advances, U.S. mortality appears to be rising, with significant demographic and geographic disparities. Methods Using CDC WONDER Multiple Cause-of-Death data, we identified U.S. adults ≥ 35 years with osteomyelitis (ICD-10 M86) as a contributing cause of death. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population, and trends analyzed with Joinpoint regression to estimate annual and average annual percent change (APC, AAPC) with 95% CIs. Results From 1999–2023, 111,115 osteomyelitis-related deaths occurred. AAMR rose from 1.7 to 4.1 (AAPC: 3.6%), peaking in 2018–2021 (APC: 13.2%). Males had higher rates than females (2023 AAMR: 5.7 vs 2.9), but both increased proportionally. American Indian/Alaska Native individuals had the highest 2023 rate (8.0) and largest post‑2010 rise, followed by Black individuals (7.1). Mortality increased with age, reaching 33.6 in those ≥ 85 years. Rural areas saw faster increases than urban areas, surpassing them by 2020. Conclusions Osteomyelitis mortality in U.S. adults more than doubled since 1999, accelerating sharply in the last decade and during the COVID‑19 pandemic. Disproportionate burdens among males, AI/AN and Black populations, the oldest adults, and rural residents highlight the need for targeted, equity‑focused interventions and improved access to preventive and specialty care.