C. diff Deaths in the U.S. Show Persistent Disparities Over 25 Years
A comprehensive review of U.S. mortality data from 1999 to 2023 reveals significant demographic, geographic, and healthcare-related differences in deaths caused by Clostridioides difficile (C. diff). The study, presented at IDWeek 2025, analyzed 216,311 deaths linked to C. diff infection using the CDC WONDER database, highlighting long-term trends and persistent disparities across populations.
C. diff Mortality by Race, Gender, and Geography
White individuals accounted for the vast majority of deaths (83.9%), with Black/African Americans representing 8.1% and Hispanic individuals 5.5%. Women were disproportionately affected, comprising 58.1% of fatalities. Geographically, one-third of deaths occurred in the South, followed by 24.4% in the Midwest, 22.2% in the Northeast, and 20.3% in the West. Metropolitan areas experienced a disproportionate share of C. diff fatalities, with 83.8% occurring in urban centers compared with 16.2% in non-metropolitan regions. At the state level, Rhode Island, Maine, Ohio, Vermont, West Virginia, and Missouri were in the top 90th percentile for crude mortality rates per 100,000 population, while Georgia, Mississippi, Louisiana, Utah, Alaska, and Hawaii had the lowest rates.
C. diff Deaths in Healthcare Settings and Trends Over Time
The majority of deaths occurred in inpatient medical facilities (71.2%), with another 15% in nursing homes or long-term care settings. Smaller proportions occurred at home, in hospice facilities, or outpatient/ER settings. Mortality rates peaked in the early 2000s, coinciding with the emergence of hypervirulent C. diff strains and rising antibiotic resistance. Since then, rates have gradually declined, reflecting improved infection control measures, antimicrobial stewardship programs, and increased public awareness.
Despite overall improvements, the analysis highlights persistent racial and regional disparities, emphasizing the need for targeted preventive strategies. These findings underscore the ongoing public health challenges posed by C. diff and the importance of sustaining efforts to reduce transmission, improve early detection, and implement evidence-based interventions across high-risk populations.
Reference
Asghar MS et al. Trends in mortality caused by Enterocolitis due to Clostridium difficile among United States population: A CDC WONDER Database Study from 1999-2023. Abstract 193. IDWeek 2025, 19-22 October, 2025.
