S1396 Disparities in Upper Gastrointestinal Bleeding Associated With Liver Cirrhosis: Epidemiological Trends in the United States (1999 to 2023): A CDC WONDER Analysis

Introduction: Liver cirrhosis remains a well-established risk factor for upper gastrointestinal bleeding (UGIB), primarily due to complications like varices and portal hypertensive gastropathy. While both conditions carry high mortality, national data examining their overlap are limited. This study analyzes U.S. mortality data to examine temporal and demographic trends in deaths where cirrhosis and upper gastrointestinal bleeding co-occurred as contributing causes of death. Methods: Liver cirrhosis associated deaths presenting with UGIB were analyzed using ICD-10 codes for upper GI hemorrhage (K92.2) and liver cirrhosis (K70.3, K71.7, K74) from the CDC WONDER (1999-2023). Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 1,000,000 were calculated using the 2000 U.S. standard populations. Trends were evaluated through Joinpoint regression, estimating annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CI) (P < 0.05). Demographic variables (sex, age, race/ethnicity) and geographic factors (census region, state, urban-rural classification, place of death) were examined. The analysis followed STROBE guidelines. Results: There were 81,915 deaths (AAMR: 9.45 per 1,000,000) due to UGIB associated with cirrhosis from 1999 to 2023 in the United States (AAPC: 0.80; CI: 0.36-1.15). Males (13.03) reported more than double the AAMR of women (5.77). Female mortality increased from 1999 to 2023 (AAPC: 1.74; CI: 1.28-2.14), with significant rise from 2018 to 2021 (APC: 15.33, CI: 10.85-18.25) and decrease post 2021 (APC: -6.45; CI: -11.76 - -0.35). Male mortality also exhibited a significant increase from 2018 to 2021 (APC: 11.83; CI: 7.87-14.28) and a decline after 2021 (APC: -8.27; CI: -12.87 - -3.18). Racial variations revealed that non-Hispanic (NH) American Indians had the greatest AAMR (30.91), followed by Hispanics (15.86). Those aged 45–64 had the highest CMR (24.01). Geographically, highest AAMR was exhibited by urban areas (9.02). The states with the lowest and highest AAMRs, respectively, were Utah (5.4) and New Mexico (21.97), whereas the West had the highest AAMR (11.8). Conclusion: The sharp rise in cirrhosis-related UGIB mortality, particularly among middle-aged adults, men, and NH American Indians, highlights the need for targeted reforms in liver disease prevention, endoscopic access, and addressing structural disparities across high-burden regions.