S2347 Demographic Disparities in Liver Disease Mortality Trends in US Women: A Nationwide Retrospective Analysis of ALD and NAFLD

Introduction: Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD), both marked by hepatic steatosis, are among the major causes of morbidity and mortality in the United States (US). Emerging evidence highlights disparities in liver disease mortality among women, particularly under racial, socioeconomic, and geographic parameters. While ALD is associated with increased use of alcohol, NAFLD has the highest increasing trend in prevalence in the US over the last 20 years given the underlying epidemic of obesity. Methods: We conducted a retrospective analysis using mortality data from CDC WONDER database for women aged ≥25 years, with ALD or NAFLD from 1999 to 2020. Temporal trends in age-adjusted mortality rates (AAMR) per 100,000 population were noted, and stratified in terms of race, urbanization, state and census region. Mortality data in different age-groups was given as crude mortality rate (CMR) per 100,000. Joinpoint was used to determine the annual percentage change (APC). Results: Between 1999 and 2020, ALD caused 447,109 deaths in the US, including 124,282 women, while NAFLD accounted for 72,647 deaths, of which 36,104 were women. ALD-related AAMR in women initially declined (1999-2003; APC -2.1), followed by a significant rise; 2003-2007 (APC 16.7), 2007-2018 (APC 4.2), and 2018-2020 (APC 14.1). During this twenty-year period, NAFLD-related mortality also increased significantly; 1999-2010 (APC 4.3), and 2010-2020 (APC 11.3). Highest mortality among women with ALD was noted in patients aged 55-64 years with a CMR of 9.8, while NAFLD-related CMR was highest among the 65-74 years age bracket (3.7). Urbanization analysis showed highest ALD-related AAMR among women in small metro areas (5.8), and the highest NAFLD AAMR was observed in micropolitan areas (1.8). Regional analysis showed highest AAMR in the West in both – ALD (8.7) and NAFLD (1.8). Alaska had the highest ALD-related AAMR (14.9), while NAFLD-related AAMR was highest in West Virginia (2.6). In terms of race, American Indian/Alaska Native population had the highest AAMR among both ALD (35.1) and NAFLD (4.3). Conclusion: A rising trend in mortality, accompanied by clear disparities, has been observed for both ALD and NAFLD in women. Particularly concerning is the higher mortality rate among American Indian women. This highlights the need to study reasons behind the noted disparities to emphasize tailored public health strategies to address the interplay of social, environment, and genetic determinants of health.