S2555 Temporal Trends in Cardiovascular Mortality in Underlying Viral Hepatitis: A Retrospective Analysis of Gender, Racial/Ethnic, and Regional Disparities

Introduction: Viral hepatitis, a leading global cause of mortality with rising deaths (1.4 million/year), drives cirrhosis and liver cancer. In the U.S. (2021), over 13,000 acute hepatitis B and 107,540 chronic hepatitis C cases were reported. Cardiovascular disease (CVD), the top U.S. killer, shares risk factors (diabetes, dyslipidemia) with liver disease, and hepatitis C/B are linked to atherosclerosis and coronary disease. Cirrhotic cardiomyopathy affects 50% of cirrhotic patients, further connecting these conditions. Despite progress, the Viral Hepatitis National Progress Report highlights unmet 2025 targets for reducing infections and deaths. Analyzing demographic and regional trends in hepatitis-related CVD mortality is critical to guide public health strategies and resource allocation in the U.S. Methods: We conducted a retrospective analysis using data from the CDC WONDER dataset. Our study cohort consisted of adults aged ≥15 years, where both cardiovascular disease and viral hepatitis were identified as underlying or contributory causes of death between 1999 and 2020. Crude and age-adjusted mortality rates (AAMR) per 1,000,000 population were extracted. Joinpoint regression analysis was utilized to calculate the annual percentage change (APC) of each trend. Results: The overall AAMR exhibited a notable increase from 15.2 in 1999 to 24.9 in 2020. However, a recent decline was observed from 2013 to 2020 (APC: −2.1; 95% confidence interval [CI]: −3.4 to −0.65). African Americans experienced the highest mortality rate, surpassing that of Whites by more than twofold (AAMR: 20.3). Middle-aged adults (35–54 years) faced the greatest mortality burden among all other age groups. Urban-rural disparities were significant, with urban areas showing substantially higher AAMRs compared to rural areas. Notably, urban AAMR decreased between 2013 and 2020 (APC: −2.7). Conclusion: Our study demonstrates rising hepatitis-related cardiovascular mortality, with significant disparities among African Americans and middle-aged adults. While recent declines reflect therapeutic advances, persistent gaps highlight the need for targeted interventions in high-risk groups and improved cardiovascular screening in hepatitis patients.