SAT-654 The Overlapping Burden of NAFLD and Associated Endocrine Disorders: A Nationwide 25-Year Analysis of Mortality Trends in the United States

Abstract Disclosure: A. Ahmed: None. H. Ahmad: None. S. Joshi: None. F. Ahmed: None. N.U. saleem: None. S. abid: None. F. Fatima: None. S. Eltawansy: None. Background: Nonalcoholic fatty liver disease (NAFLD) and endocrine disorders (EDs), including diabetes, hypothyroidism, adrenal dysfunction, obesity, and dyslipidemia, are interconnected through complex metabolic pathways, insulin resistance, and systemic inflammation. Their coexistence significantly elevates morbidity, cardiovascular risk, and mortality. This study aims to assess nationwide mortality trends and the evolving burden of these conditions over the past 25 years. Methods: Mortality data from the CDC WONDER database were analyzed for the period 1999-2023 to investigate deaths related to NAFLD and associated EDs among U.S. adults aged 25 and older. Age-adjusted mortality rates (AAMRs) per million persons were calculated, along with annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Results: From 1999 to 2023, NAFLD and its associated EDs were responsible for 164,554 deaths. The overall AAMR demonstrated a significant upward trajectory throughout the study period, with an AAPC of 3.56 (95% CI: 3.26, 3.99). The most pronounced increase occurred between 2018 and 2021, with a staggering APC of 15.74 (95% CI: 13.13, 17.58). Men experienced higher AAMR compared to women (33.12 vs 23.51), yet women exhibited a more substantial rate of increase (AAPC: 3.65) relative to men (AAPC: 3.54). The period from 2018 to 2021 saw a dramatic surge in mortality, with females shouldering a higher burden than their male counterparts (APC: 17.41 vs 14.56). The highest AAMR was recorded among American Indian or Alaska Native populations (78.79), followed by Hispanic or Latino (50.75), and White individuals (26.54). Notably, White individuals experienced the most astounding increase in mortality among all racial groups, with an AAPC of 4.09 (95% CI: 3.81, 4.52). Geographically, the West region exhibited the highest AAMR (32.29), followed by the South (30.63) and the Midwest (25.20). Surprisingly, the South experienced the most dramatic increase in mortality (AAPC: 4.38, 95% CI: 4.11, 4.78). Rural areas consistently reported higher AAMR than urban settings (29.17 vs 24.74). Among states, Oklahoma recorded the highest AAMR (88.55), while New York had the lowest (20.56). Among age groups, individuals aged 75 and older displayed the most concerning increase in mortality, with an AAPC of 4.33 (95% CI: 4.07, 4.61). Conclusion: Overall, mortality trends have steadily increased from 1999 to 2020, with a particularly alarming surge from 2018 to 2020, especially among women, Whites, rural areas, and the South region. These findings emphasize the urgent need for targeted interventions to address both the rising mortality and the disparities across different epidemiological groups. Presentation: Saturday, July 12, 2025