S2456 Geographic and Demographic Patterns of Esophageal Varices Deaths in Cirrhotic U.S. Adults Aged 55 and Older From 1999-2023

Introduction: Esophageal varices, a critical complication of liver cirrhosis driven by portal hypertension, account for 30-50% of life-threatening upper gastrointestinal bleeding events in cirrhotic patients, significantly contributing to mortality. Despite advances in management, persistent disparities in outcomes necessitate a population-level analysis to identify evolving trends and high-risk subgroups. Methods: This retrospective study analyzed U.S. mortality data (1999-2023) from the CDC WONDER database to investigate deaths related to liver cirrhosis (International Classification of Diseases, Tenth Revision [ICD-10] K74) and esophageal varices (I85) among adults aged ≥55. Age-adjusted mortality rates (AAMR per 1,000,000) were calculated using the 2000 U.S. standard population. Trends were evaluated via segmented log-linear regression (Joinpoint 5.0.2), reporting annual percent change (APC) and average APC (AAPC) with 95% confidence intervals (CIs). Analyses were stratified by demographics, region, state, and urbanization. Results: A total of 23,085 deaths were recorded (overall AAMR: 11.51). Mortality declined from 15.3 in 1999 to 7.6 in 2006 (APC: -14.50, P = 0.08), then surged to 14.4 by 2023 (APC: 3.78, P < 0.01). Men had double the mortality rate of women (AAMR: 15.71 vs 7.90), with women demonstrating a steeper post-2007 increase (APC: 4.57 vs 3.24 in men). Racial disparities were pronounced, with Whites exhibiting higher mortality than Blacks (AAMR: 11.79 vs 9.53). White AAMR declined from 15.3 in 1999 to 7.4 in 2006 (APC: -14.64, P = 0.08), then rebounded sharply to 15.7 by 2023 (APC: 4.31, P < 0.001). In contrast, Blacks showed a modest decline (12.3 to 9.4, 1999-2006; APC: -5.78, P = 0.04) followed by stable rates (APC: -0.45, P = 0.49). Hispanics or Latinos exhibited a higher mortality rate than non-Hispanics (AAMR: 22.27 vs 10.58). Geographically, the South showed the steepest rise (APC: 4.86, P < 0.001), surpassing the West by 2023 (AAMR: 16.4 vs 14.3). Texas (25.1) and Colorado (24.3) emerged as high-mortality states. Conclusion: The post-2006 mortality resurgence underscores systemic inequities linked to alcohol-related liver disease, viral hepatitis, and metabolic syndrome, disproportionately impacting men, Hispanics, and Southern and Western regions. Prioritizing early portal hypertension management, equitable care access, and policies targeting alcohol misuse and obesity is critical to reversing this trend.