National Trends in Oral Cavity and Pharyngeal Cancer Incidence, Sepsis Hospitalizations, and Clostridioides difficile Infection in the United States, 2011- 2020

Background. Sepsis, Clostridioides difficile infection (CDI), and oral cavity and pharyngeal cancers are high burden conditions monitored separately by U.S. national surveillance systems. Comparing their national trajectories over the same decade shows how different forces, namely infection prevention, diagnostic and coding practice, and changing cancer risk factors, move disease indicators in different directions. Methods. This descriptive, ecological trend analysis used publicly available aggregate data for 2011-2020: sepsis hospitalization rates, costs, and length of stay (LOS) from HCUP Fast Stats and HCUPnet; CDI hospitalization rates from a published HCUP National Inpatient Sample analysis (Malik et al.); and age adjusted oral cavity and pharyngeal cancer incidence from CDC United States Cancer Statistics. Hospitalization rates are per 10,000 discharges and cancer incidence is per 100,000 population, so the series are compared by direction, not magnitude. Trends were estimated with simple linear regression on calendar year. Because 2020 coincided with the COVID-19 pandemic and sepsis coding changed in October 2015, sensitivity analyses excluded 2020 and examined sub-periods. Results. Sepsis hospitalizations rose from 337.1 to 725.4 per 10,000 discharges (+46.5 per year; 95% CI 40.7 to 52.3; P < .001). CDI hospitalizations rose slightly from 115.4 to a peak of 121.6 in 2015, then fell to 78.1 in 2020 (linear slope -4.0 per year; 95% CI -6.3 to -1.8; P = .003; -8.9 per year from 2015 to 2020). Oral cavity and pharyngeal cancer incidence rose from 11.6 to 12.3 per 100,000 between 2011 and 2019, then fell to 11.7 in 2020. The 2011-2020 trend was not significant (+0.055 per year; P = .058), but the 2011-2019 trend was (+0.095 per year; R² = 0.90; P < .001), indicating that the 2020 value drives the non-significant result. Sepsis stays cost about 1.5 to 1.8 times, and lasted about 1.5 to 1.8 times as long as, the average inpatient stay; mean sepsis cost rose from $18,377 to $23,170 (2020 USD). Conclusions. Over 2011-2020, sepsis hospitalizations rose steadily, CDI hospitalizations fell after 2015, and oral cavity and pharyngeal cancer incidence rose modestly until a 2020 dip likely related to the pandemic. These aggregate, ecological findings are consistent with, but cannot establish, the effects of infection prevention, coding changes, and shifting cancer epidemiology. Patient level linked data are needed to test connections between these conditions.