S2402 Trends and Disparities in Sepsis and Liver Cirrhosis Mortality in the United States: A Nationwide Analysis

Introduction: Mortality due to sepsis in patients with liver cirrhosis ranges from 18% to 66%, with evidence suggesting a rising trend over time. Despite this high burden, temporal and demographic patterns of sepsis-associated mortality among patients with liver cirrhosis in the U.S. are not well known. Analyzing these patterns is essential for targeted public health interventions, improving clinical outcomes, and reducing mortality in high risk populations. In this study, we leveraged a large national database to analyze mortality trends from 1999 to 2020. Methods: Mortality data from the CDC WONDER database were analyzed for sepsis and cirrhosis from 1999 to 2020. Age-adjusted mortality rates (AAMRs) were calculated per 1,000,000 individuals. Annual percent change (APC) and average annual percent change (AAPC) were computed using Joinpoint regression. Trends were stratified by year, sex, race/ethnicity, urbanization status, and geographic region. Results: From 1999 to 2020, there were 118,846 deaths due to sepsis and liver cirrhosis in the United States, with an overall AAMR of 15.8. The AAMR rose from 11.1 in 1999 to 12.6 in 2008 (APC: 1.63), and to 24.9 in 2020 (APC: 5.53; AAPC of 3.84). Men had higher AAMRs than women (AAMR Male 20.6; Female: 11.6). Both had a parallel increase in AAMR from 1999 to 2020 (AAPC Men 3.40; Women 4.62). Non-Hispanic (NH) American Indian or Alaska natives had the highest mortality rate followed by Hispanic, NH White, NH Black and NH Asian or Pacific Islander (overall AAMR (NH) American Indian: 38.3; Hispanics: 28.8; NH Whites: 16; NH Blacks: 15.9; Asian: 9.1). NH American Indians also had the greatest increase in mortality rate (1999-2020 AAPC NH American Indians: 4.47; NH Whites: 4.38; Hispanics: 2.37; Asians: 1.36; and NH Black: 1.25). Regionally, the West had the highest AAMR (AAMR West: 19.1; South: 17.3; Midwest: 12.9; Northeast: 12.8). The Midwest had the highest increase in mortality rate (AAPC Midwest: 4.33; West: 4.15; South: 3.88; Northeast: 1.92). Urban areas had higher AAMRs than rural (AAMR Metro: 16; Nonmetro: 15.4). Conclusion: Mortality from sepsis and liver cirrhosis continues to rise in the U.S., with racial and regional disparities disproportionately affecting minorities. Male Hispanics and the West reported consistently higher mortality rates. Targeted health policy interventions and further research are needed to address these disparities and improve outcomes for all affected populations.