S2378 Fall-Related Mortality in Middle-Aged and Older Adults (≥45 Years) With Liver Cirrhosis: A US Nationwide Analysis From 1999 to 2023

Introduction: Liver cirrhosis affects over 4.5 million adults in the United States (U.S.) and is a leading cause of liver-related morbidity and mortality, particularly among middle-aged and older adults. It is associated with complications such as hepatic encephalopathy, sarcopenia, and coagulopathy, which increase the risk of falls and related injuries. Despite the growing burden of cirrhosis, fall-related mortality in this at-risk population has been relatively overlooked. Methods: We used CDC WONDER death certificate data from 1999 to 2023 to identify U.S. adults aged ≥45 years with cirrhosis (International Classification of Diseases, Tenth Revision [ICD-10]: K70.2, K70.3, K71.7, K72.1, K72.9, K74.0, K74.1, K74.2, K74.6, K76.6, K76.7, I85.x) who died from falls (ICD-10: W00–W19) as the underlying cause of death. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, age group, ethnicity, census region, state, and urbanization status (urbanization data available through 2020). Temporal trends were evaluated using average annual percent change (AAPC) with 95% confidence intervals; P-values < 0.05 were considered statistically significant. Results: Between 1999 and 2023, there were 10,029 fall-related deaths in the U.S. among middle-aged and older adults with cirrhosis. The AAMR increased significantly from 1.5 per 1,000,000 in 1999 to 5.5 in 2023 (AAPC: 5.30; 95% CI: 4.74 to 5.89; P < 0.001). Men had a higher AAMR than women (4.2 vs 2.0). Older adults (≥65 years) had a higher AAMR (4.1) compared to middle-aged adults (45–64 years) (2.5). When stratified by ethnicity, the Hispanic or Latino population had a higher AAMR (4.5) than the non-Hispanic (NH) population (2.9). Metropolitan/urban areas reported a higher AAMR than non-metropolitan/rural areas from 1999 to 2020 (3.0 vs 2.4). Based on U.S. Census regions, the West had the highest AAMR (4.0), followed by the Midwest (2.9), South (2.8), and Northeast (2.5). States that remained in the top 90th percentile of AAMR throughout the study period included Colorado, New Mexico, Minnesota, Oklahoma, and Rhode Island. Conclusion: Fall-related mortality among adults with cirrhosis has increased substantially in the U.S. from 1999 to 2023, with disproportionately higher rates observed in men, older adults, Hispanic or Latino individuals, and residents of metropolitan areas and the Western region. These findings emphasize the critical need for implementing focused preventive measures to reduce fall-related mortality in high-risk cirrhotic populations.