S2588 Unveiling Disparities in Liver Cirrhosis–Related Mortality in the United States: A 24-Year Longitudinal Analysis (1999–2023)

Introduction: Liver cirrhosis remains a significant cause of morbidity and mortality in the United States. Although previous studies have reported national death rates related to cirrhosis, the rising burden of nonalcoholic fatty liver disease and the continued impact of alcohol-associated liver disease, highlight the importance of updated analyses. This study aims to characterize temporal trends and regional variations in cirrhosis-related mortality of different demographic populations. Methods: We performed a retrospective analysis study of U.S. adults using the CDC WONDER Multiple Cause of Death database from 1999 to 2023. Liver cirrhosis deaths were identified via International Classification of Diseases, Tenth Revision (ICD-10) codes K70.3 and K74. Annual age-adjusted mortality rates per 100,000 population were calculated using the direct standardization method, applying the 2000 U.S. standard population. We stratified analyses by sex, race/ethnicity, and U.S. Census region. Joinpoint regression identified inflection points in the trend lines and computed Annual Percent Change (APC) with 95% confidence intervals. Results: The overall age-adjusted mortality rate (AAMR) rose from 13.7 (95% CI: 13.5–13.8) in 1999 to 15.9 (95% CI: 15.8–16.1) in 2023, peaking at 16.8 (95% CI: 16.7-17) in 2021. Joinpoint analysis revealed significant nationwide acceleration from 2018 to 2021 (APC: 6.74). Women experienced a steeper increase during this period (APC: 8.33) followed by a plateau, while men showed a significant steady increase from 2008 to 2023 (APC 1.80). Notable racial disparities included a marked increase among American Indian/Alaska Native individuals from 2018–2020 (APC 12.34), followed by Black individuals for the same period (APC 6.30), and a steady rise for White individuals from 2008 to 2020 (APC 2.34). In contrast, Asian/Pacific Islanders saw a decline from 1999 to 2015 (APC -1.81). Geographically, the West had the sharpest recent increase from 2018 to 2021 (APC 9.03), while the South and Midwest demonstrated sustained upward trends beginning in 2008 and 2009, respectively. Conclusion: These findings underscore a growing national burden of cirrhosis-related mortality, particularly among women, American Indian/Alaska Native, and Black populations, and in Western regions, highlighting the need for targeted public health interventions focused on modifiable risk factors such as nonalcoholic fatty liver disease and alcohol use.