Racial and Ethnic Disparities in Fracture Mortality Trends in the United States, 2014-2024: A 11-Year Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC Wonder) Analysis.

Introduction Fractures, particularly those related to falls and osteoporosis, are a major cause of morbidity and mortality among older adults. Despite advances in orthopedic care and fracture prevention, racial and ethnic disparities in fracture-related mortality remain poorly characterized. This study examines 11-year trends in fracture mortality across racial and ethnic groups in the United States to (i) evaluate temporal trends in fracture-related age-adjusted mortality rates within individual racial/ethnic cohorts and (ii) to characterize the persistence of absolute disparities across the study period. Methods Mortality data from 2014 to 2024 were extracted from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause of Death database using ICD-10 codes for fractures (S12-S92, M80-M82). Age-adjusted mortality rates (per 100,000 population; 2000 U.S. standard) were stratified into five mutually exclusive demographic cohorts, using an ethnicity-first classification for Hispanic individuals (all races combined). Temporal trends were analyzed using log-linear regression to estimate the annual percent change (APC) and associated p-values. Statistical significance was set at p < 0.05. Results From 2014 to 2024, fracture-related mortality declined across all racial and ethnic groups. Statistically significant decreases were observed among Hispanic (all races) adults (APC = -13.2%, p=0.047). Non-Hispanic Asian or Pacific Islander (APC = -20.17%, p = 0.065), non-Hispanic White (APC = -4.48%, p = 0.089), and non-Hispanic American Indian or Alaska Native (APC = -7.97%, p = 0.123) groups showed nonsignificant downward trends. Non-Hispanic Black adults consistently had the highest fracture mortality rates, while Asian or Pacific Islander adults had the lowest. Discussion Fracture-related mortality declined from 2014 to 2024 in the United States; however, racial and ethnic disparities persist. Non-Hispanic Black adults continue to experience disproportionately higher mortality, highlighting the need for improved equity in fracture prevention, treatment, and post-fracture care.