S1391 A Deadly Duo: Twenty-5 Year US Mortality Trends in Upper GI Bleeding Related Mortality Among Adults With Liver Cirrhosis

Introduction: Liver cirrhosis (LC), often complicated by portal hypertension, is a major cause of upper gastrointestinal bleeding (UGIB), a medical emergency with high mortality. The progression from compensated cirrhosis to variceal hemorrhage reflects both disease severity and gaps in surveillance and management. Despite their frequent clinical overlap, national trends in mortality involving both UGIB and LC remain underreported. This study evaluates U.S. mortality patterns from 1999 to 2023, focusing on demographic and geographic disparities in UGIB and LC–related deaths. Methods: Mortality data were obtained from CDC WONDER (1999–2023) using ICD-10 codes for UGIB and LC. Age-adjusted mortality rates (AAMRs) per 100,000 were computed using the 2000 U.S. standard population. Joinpoint regression identified Annual Percent Change (APC) and Average Annual Percent Change (AAPC), with P < 0.05 considered significant. Analyses were stratified by sex, age, race/ethnicity, region, urbanization, and state. Results: There were 121,512 UGIB and LC-related deaths, 69% of which occurred in inpatient settings. The overall AAMR increased from 2.33 in 1999 to 2.79 in 2023 (AAPC: 0.58%, 95% CI: 0.24–0.88, P = 0.0004). Men had a 167% increase in AAMR as compared to women (3.2 vs 1.2), though women showed a sharper rise over time (AAPC: 1.4% vs 0.1%). Middle-aged adults (45–64) had the highest mortality (AAMR: 3.5), followed by older adults 65+ (3.1) and younger adults 25–44 (0.7), but the steepest increase was seen in younger adults (AAPC: 1.5%, P < 0.000001). Non-Hispanic (NH) American Indians had both the highest AAMR (7.9) and the steepest rise (AAPC: 2.7%, 95% CI: 1.7–3.6, P < 0.000001), while NH Blacks showed the largest decline (AAPC: –1.4%). The West had the highest regional AAMR (2.8) and steepest increase (AAPC: 0.9%). States in the top 90th percentile included New Mexico, South Dakota, Alaska, Wyoming, and Colorado. Rural areas had slightly higher AAMRs than urban areas (2.08 vs 2.06) but a markedly steeper rise (AAPC: 2.1% vs 0.1%). Conclusion: From 1999–2023, UGIB and LC–related mortality increased in the U.S., with the sharpest rises among women, younger adults, and NH American Indians. Rural areas and Western states also showed disproportionate increases, underscoring the need for targeted prevention in vulnerable populations.