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Introduction Cyclic vomiting syndrome (CVS) is a chronic disorder characterized by recurrent episodes of severe vomiting, yet population-level data on sex- and race-based disparities in outcomes remain limited. We evaluated differences in healthcare utilization and clinical outcomes among adults with CVS.Methods We performed a retrospective cohort study using the TriNetX Global Collaborative Network. Adults (≥18 years) with CVS were identified by ICD-10 codes (R11.15, G43.A). The index event was first CVS diagnosis; outcomes were assessed over 3 years. Primary outcomes included all-cause hospitalization, all-cause mortality, complications of severe vomiting, diagnostic testing intensity, and prophylactic medication use (amitriptyline, nortriptyline, doxepin, aprepitant, topiramate, levetiracetam, zonisamide). Outcomes were analyzed using risk estimates with 95% confidence intervals (CI), stratified by sex and race/ethnicity.Results Among 148,074 adults with CVS, Over the 3 years follow up window, the risk of all cause hospitalization was 3.1%, prophylactic medication use occurred in10.8%, and diagnostic testing intensity was observed in 19.6%. Vomiting-related complications occurred in 11.9%, and all-cause mortality was 4.8%.Hospitalization risk was higher in Black (3.46%, 95% CI 3.24–3.70) and Asian patients (3.32%, 2.80–3.93) compared with White patients (2.64%, 2.55–2.74). All-cause mortality was markedly higher in Black patients (10.11%, 9.71–10.53) compared with White (5.19%, 5.05–5.32) and Hispanic patients (2.95%, 2.67–3.26). Complications of severe vomiting were most frequent in Hispanic (23.51%, 22.50–24.54) and Black patients (16.94%, 16.34–17.55), compared with White patients (12.29%, 12.06–12.53). Diagnostic testing intensity was highest among American Indian/Alaska Native (27.88%, 24.87–31.11) and Hispanic patients (23.51%, 22.50–24.54), while Asian patients had the lowest (13.80%, 12.50–15.22). Prophylactic medication use was higher in females (12.23%, 12.00–12.46) than males (8.71%, 8.46–8.97), and lowest in Asian patients (7.47%, 6.66–8.38).Conclusions Significant sex- and race-based disparities exist in CVS outcomes. Black and Hispanic patients experience higher mortality and complication burdens, while American Indian/Alaska Native and Hispanic patients undergo greater diagnostic testing. Females receive more prophylactic therapy than males. These findings highlight inequities in disease burden and healthcare utilization in CVS and support the need for targeted strategies to improve equity in care.