Mapping the national burden of cellulitis and related conditions in the United States, 1999–2024: a retrospective cohort analysis

Abstract

Background: Cellulitis is a common bacterial skin infection associated with substantial morbidity and economic burden in the United States, yet long-term national mortality trends remain poorly characterized. Methods: We analyzed multiple cause-of-death data from CDC WONDER from 1999 through 2024 using ICD-10 codes L03, H60, K12.2, and L98.3. Age-adjusted mortality rates (AAMRs) per 100 000 were calculated using the 2000 US standard population, with temporal trends assessed via Joinpoint regression across demographic, geographic, and urbanization subgroups. Results: A total of 139 485 cellulitis-related deaths were identified over the study period. The overall AAMR was 1.5 per 100 000, remaining stable from 1999 through 2011 before increasing significantly through 2024 [annual percent changes (APC): 2.39%, P = 0.0016]. Mortality rose sharply with age, with adults aged ≥85 years accounting for 31.0% of all deaths. Men had consistently higher AAMRs than women (1.7 vs. 1.4). NH American Indian or Alaska Native persons bore the greatest racial/ethnic burden (AAMR: 2.2), with rates rising from 2.2 in 1999 to 3.5 by 2024. The West and Midwest recorded the highest regional AAMRs (1.7 and 1.6, respectively), and nonmetropolitan areas sustained higher and more volatile mortality than metropolitan areas throughout (1.7 vs. 1.4). Conclusion: Cellulitis-related mortality increased significantly over recent decades and exhibits pronounced demographic and geographic disparities. Targeted prevention strategies, improved access to timely care for high-risk populations, and strengthened public health surveillance are needed to reduce this burden.