S2396 Trends and Disparities in Mortality Due to Alcoholic Cirrhosis in the United States: A Decadal Analysis Using CDC WONDER (1999-2023)

Introduction: Alcoholic cirrhosis is emerging as a growing cause of liver-related deaths in the U.S., coinciding with a decline in hepatitis-related mortality. Recent trends show sharp increase, particularly among younger adults, women, and racial minorities. This study analyzes national data from 1999–2023 to examine evolving patterns and disparities in alcoholic cirrhosis mortality. Methods: Death certificates from CDC WONDER database were examined from 1999 to 2023 for multiple causes of death UCD-ICD 10 Codes (K70.3). Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by gender, race/ethnicity, 10-year age groups and census region. Join-Point analysis was performed to estimate annual percent change (APC). Results: From 1999 to 2023, 329,223 deaths occurred in adults >25 years due to alcoholic cirrhosis. Overall AAMR rose from 4.09 in 1999 to 4.92 in 2011 (APC: 1.45%,95% CI: –0.14 to 2.76), then sharply to 10.6 in 2021 (APC: 7.02%, 95% CI: 3.35 to 10.78, P = 0.03), before declining to 8.93 in 2023 (APC: –10.9%, 95% CI: –5.72 to 5.71). By gender, man AAMR increased from 6.69 to 12.43, and woman AAMR from 1.9 to 5.63, both peaking in 2021 (men: 14.11; women: 6.25). A sharp rise occurred from 2018–2021 (men APC: 11.06%; women APC: 14.43%, P < 0.000001), followed by a decline through 2023 (men APC: –5.51%; women APC: –4.76%).Age-specific rates rose in both groups (25–64: 3.71 to 8.41; 65+: 5.64 to 11.00), with a steeper rise in the younger group, both peaking in 2021. By race, NH American Indians had the highest 2023 AAMR (39.87), followed by Hispanics (10.84), NH Whites (9.54), and NH Blacks (5.06). NH American Indians showed a dramatic pandemic peak in 2021 (64.69). Regionally, the West had the highest 2023 AAMR (12.93), followed by the South (8.32), Midwest (8.24), and Northeast (5.64). Conclusion: Alcoholic cirrhosis mortality has more than doubled in 2 decades, with surges during COVID-19, especially in younger adults, women, and NH American Indians. The recent decline post-2021 offers hope but highlights a critical window for intervention. These findings emphasize the urgent need for targeted public health strategies, improved addiction treatment access, and culturally tailored prevention programs. Our study quantifies this shifting landscape and calls for policy reform to reduce preventable alcohol related deaths.