S2457 Twenty-Five-Year Mortality Trends in Older Adults With Coexisting Liver Cirrhosis and Acute Renal Failure in the United States: A CDC Multiple Cause of Death Analysis (1999–2023)

Introduction: Older adults with coexisting liver cirrhosis and acute renal failure face significantly elevated mortality risks due to compounded organ dysfunction, systemic inflammation, and limited treatment options. This study analyzes trends in mortality related to liver cirrhosis and acute renal failure among older adults in the United States from 1999 to 2023. Methods: We extracted mortality data among adults aged ≥55 from the CDC WONDER database utilizing International Classification of Diseases, Tenth Revision codes K74 (liver cirrhosis) and N17 (acute renal failure). Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons and stratified by sex, race/ethnicity, census region, and urbanization status. Joinpoint regression identified temporal trends, estimating annual percentage changes (APCs) with 95% confidence intervals (CI). Results: From 1999 to 2023, 41,615 deaths were attributed to coexisting liver cirrhosis and acute renal failure in the United States. AAMR steadily increased till 2019 (APC: 4.50; 95% CI, 3.71 to 5.30; P < 0.000001), then sharply accelerated by 2023 (APC: 20.05; 95% CI, 14.21 to 26.18; P < 0.000001). Although men had a higher AAMR than women, a greater rise in mortality (2019-2023) was seen in men (APC: 18.73; 95% CI, 13.06 to 24.67; P < 0.000001). Regionally, the Northeast (2019-2023) exhibited the most pronounced rise (APC: 22.83; 95% CI, 14.28 to 32.02; P = 0.000008). During the same period, the Midwest, West, and South regions showed uptrends with APCs of 22.50 (95% CI, 14.03 to 31.60; P = 0.000009), 20.15 (95% CI, 13.05 to 27.69; P = 0.000004), and 17.82 (95% CI, 12.30 to 23.63; P = 0.000001), respectively. Racially, AAMR increased among all the groups, and the Whites experienced the highest number of deaths (35,673). From 2019 to 2023, the non-Hispanics had a higher APC (21.03; 95% CI, 15.06 to 27.31; P < 0.000001) than the Hispanics (14.23; 95% CI, 6.72 to 22.27; P = 0.000580). Micropolitan and Small Metropolitan areas showed consistent uptrends throughout the study period with APCs of 5.47 (95% CI, 4.83 to 6.13; P < 0.000001) and 4.50 (95% CI, 3.76 to 5.24; P < 0.000001), respectively. Conclusion: Mortality from liver cirrhosis and acute renal failure among older adults in the U.S. increased significantly, particularly since 2019, with marked demographic and regional disparities. These findings underscore the urgent need for targeted preventive and therapeutic strategies among the high-risk groups.