Title : Trends and demographic disparities in hydrocephalus related mortality in the United States, 1999–2024: A national CDC WONDER analysis with forecasting to 2035
Abstract:
Background: Hydrocephalus remains a significant neurological disorder associated with substantial mortality, yet contemporary national trends and future projections of hydrocephalus-related mortality in the United States remain poorly characterized. This study evaluated long-term mortality patterns, demographic disparities, geographic variation, and future mortality forecasts using nationwide death certificate data.
Methods: A retrospective population-based study was conducted using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause-of-Death database from 1999 to 2024. Adults aged ≥25 years with hydrocephalus (ICD-10 code G91) listed as the underlying cause of death were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs) and average annual percent changes. Mortality patterns were stratified by sex, race/ethnicity, age, U.S. Census region, and urban-rural residence. Future mortality trends through 2035 were projected using autoregressive integrated moving average (ARIMA) modeling.
Results: A total of 68,019 hydrocephalus-related deaths occurred between 1999 and 2024. Overall AAMRs remained relatively stable until 2018 before increasing significantly through 2024 (APC 5.21%, P=0.012), rising from 1.1 to 1.6 deaths per 100,000 population. Mortality was consistently higher among males than females (2024 AAMR: 1.9 vs. 1.3 per 100,000). Black individuals experienced the highest mortality burden by 2024 (AAMR 1.8 per 100,000) and demonstrated the fastest recent increase (APC 6.53%, P<0.001). Adults aged ≥65 years exhibited the greatest mortality burden (AAMR 5.4 per 100,000 in 2024), while nonmetropolitan counties consistently had higher mortality than metropolitan counties. Geographic disparities widened over time, with the highest mortality concentrated in the Midwest and Western United States. ARIMA(0,1,0) forecasting predicted stabilization of mortality rates at approximately 1.6 deaths per 100,000 population through 2035, although prediction intervals progressively widened over time.
Conclusions: Hydrocephalus-related mortality in the United States has increased significantly during the past decade, with persistent disparities across sex, race, age, geography, and urban-rural residence. Older adults, Black individuals, and residents of nonmetropolitan areas bear a disproportionate mortality burden. Although mortality is projected to plateau through 2035, the persistence of demographic and geographic inequities highlights the need for targeted public health strategies, improved access to specialized neurosurgical care, and earlier diagnosis to reduce hydrocephalus-related mortality.
