S2491 Young and Dying: A 21-Year Longitudinal Analysis of Rising Cirrhosis Mortality Among U.S. Adults Aged 25–44, Fueled by Alcohol Use

Introduction: Cirrhosis, which once was a condition affecting older and substance exposed individuals due to a longer time frame of alcohol intake and easy access to opioids, respectively, has now started to affect younger individuals. This study examines trends and demographic variations in mortality related to cirrhosis of liver due to alcohol use among U.S. adults aged 25-44 from 1999 to 2020. Methods: Mortality data were extracted from the CDC WONDER database using International Classification of Diseases, Tenth Revision codes for alcoholic cirrhosis of liver (K70.3). Age-adjusted mortality rates (AAMRs) and crude mortality rates per 100,000 individuals were stratified by race, gender, urbanization, state and census region. Trends were analyzed using Joinpoint regression to determine annual percent change (APC) with 95% confidence intervals. Results: From 1999 to 2020, 34,716 deaths were reported due to alcoholic cirrhosis of the liver. Overall, the Age-Adjusted Mortality Rates (AAMRs) declined from 1.2 in 1999 to 0.09 in 2001 (APC = –21.97% ), then increased from 1.4 in 2004 to 2.9 in 2018 (APC = 5.33%), followed by a sharp rise to 4.8 in 2020 (APC = 28.35%). Men had consistently higher AAMR than women from 1999 (AAMR men: 1.8 vs women: 0.7) to 2020 (AAMR men: 6.2 vs women: 3.5). Non-Hispanic(NH) American Indians or Alaska Native had the highest overall AAMR (10.7), followed by NH White Americans (5.3), Hispanics or Latinos (2.6), NH Blacks or African Americans (1) and NH Asians or Pacific Islander adult (0.6). AAMR also varied substantially by region (overall AAMR: West: 3.92, Midwest: 1.81, South: 1.81, Northeast: 1.7). Noncore (non-metro) and micropolitan (non-metro) had higher AAMR (2.4 each) compared to Small metro (2.2), medium metro (2.2), large central metro (2.1) and lastly, large fringe metro (1.4). Conclusion: Following a period of steady decline from 1999 to 2001, Alcoholic liver cirrhosis-related mortality in U.S. adults aged 25-44 years has increased with a sharp rise in 2018 onwards. Men, NH - American Indian or Alaska natives, and patients living in the Midwestern and nonmetropolitan United States showed the highest AAMR. Targeted strategies and public health measures to regulate risk factors and precipitating events are needed to prevent and treat Alcoholic cirrhosis of the liver among young adults to curb increasing levels of Alcoholic liver cirrhosis-related mortality.