Alcohol use and liver cancer mortality in the U.S. (1999–2020): A CDC WONDER analysis.

e13535 Background: Alcohol consumption is a major risk factor for liver cancer, contributing to preventable mortality. This study examines trends in U.S. alcohol-related liver cancer mortality (1999–2020), stratified by demographics, geography, and socioeconomic factors to identify disparities and guide public health interventions. Methods: Mortality data from CDC WONDER were analyzed for adults aged 35+ from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per million were calculated by gender, race/ethnicity, urbanization, and region. Trends were assessed using Joinpoint regression to determine the average annual percentage change (AAPC) with statistical significance (p-values). Results: Alcohol-related liver cancer caused 30,222 deaths from 1999 to 2020, with AAMRs increasing from 4.38/million in 1999 to 8.61/million) in 2020 (AAPC: 3.32%; p &lt; 0.000001). Gender: Males (25,181 deaths, AAMR: 10.65/million) had significantly higher mortality than females (5,041 deaths, AAMR: 1.92/million). Race: American Indians had the highest AAMR per million(17.4), followed by Hispanics (10.86), Blacks (7.4), and Whites (5.3). The highest AAMR for American Indians was recorded in 2019 (25.86/million). Geography: The South had the most deaths (10,388), while the West had the highest AAMR (9.22/million). Urban vs. Rural: Rural AAMRs (6.22/million) exceeded urban (5.97/million), with rural mortality rising faster (AAPC: 4.42%; p &lt; 0.000001). Place of death: Most deaths occurred at home (11,215), followed by inpatient facilities (10,440). Conclusions: Alcohol-related liver cancer mortality rose significantly from 1999 to 2020, with disparities by gender, race, and geography. Males, American Indians, and rural residents are disproportionately affected. Targeted interventions in high-risk populations are urgently needed. Cohort Age Adjusted Mortality Rate Average Annual Percentage Change 95% Confidence Interval P value 1968-1978 1979-1998 1999-2020 2021-2023 Overall 3072.99 3226.03 2623.37 2205.23 -0.5779* -0.5939 to -0.5584 &lt; 0.000001 Males 3914.3 4164.51 3174.24 2584.94 -0.6969* -0.7148 to -0.6761 &lt; 0.000001 Females 2495.31 2630.05 2235.98 1924.98 -0.4875* -0.5109 to -0.464 &lt; 0.000001 Black or African American 3559.19 4093.77 3082.27 2455.6 -0.6105* -0.6462 to -0.5754 &lt; 0.000001 White 3032.26 3166.74 2623.46 2248.03 -0.5180* -0.5358 to -0.4971 &lt; 0.000001 Ages 25 -44 373.69 290.93 207.15 175.43 -1.6094* -1.6433 to -1.5741 &lt; 0.000001 Ages 45 - 64 2776.13 2651.73 1851.3 1474.21 -1.1679* -1.1869 to -1.1491 &lt; 0.000001 Ages 65+ 9963.27 11160.18 9680.82 8278.85 -0.2791* -0.304 to -0.2512 &lt; 0.000001 Northeast 3305.75 3351.14 2605.45 2055.82 -0.8818* -0.9001 to -0.8636 &lt; 0.000001 Midwest 3080.29 3240.08 2742.46 2344.89 -0.4931* <jats:td colspan=