S2838 Comparative Analysis and Forecasting of Nationwide Mortality Trends in Liver Cirrhosis vs Alcoholic Cirrhosis of Liver in the US Population Using CDC Wonder Database (1999-2023) and ARIMA Model

Introduction: In 2023, an estimated 2 million adults in the United States were affected by cirrhosis highlighting the sustained burden of liver disease, particularly the alcohol-induced cases. This study aims to provide a comparative analysis of mortality trends in overall liver cirrhosis and alcoholic liver cirrhosis in the U.S. population from 1999 to 2023. Methods: This epidemiological study was conducted using data sourced from CDC WONDER database (1999-2023). We calculated age- adjusted mortality rate (AAMR) per 100,000 population in several demographic and geographic variables for a comparative analysis between liver cirrhosis (k-74) and alcohol-induced liver cirrhosis (k-70.3) in adults aged >45 years. Annual percentage changes (APCs) were assessed using Monte-carlo permutation test in Joinpoint regression (JPR) analysis. An autoregressive integrated moving average (ARIMA) approach was employed to forecast AAMRs from 2024 to 2035, which was validated through Ljung-box test. Results: From 1999-2023, Liver Cirrhosis accounted for 441,182 deaths with mean AAMR of 13.24 (14.5 till 2035; Ljung-box test P-value = 0.177). While 284,920 deaths occurred due to Alcoholic Cirrhosis of liver with rising AAMR of 6.3 in 1999 and 13.0 in 2023 (16.14 till 2035; Ljung-box test P-value = 0.604). Male (1999-2009) showed non-significant rise in liver cirrhosis mortality in contrast to significant decline in mortality rate due to Alcoholic Cirrhosis with APC of -1.21 (95% CI: -1.89 to -0.57; P = 0.02). Hispanics exhibited a notable rise in alcoholic cirrhotic mortality from 2004-23 with APC of 2.17 (95% CI: 1.76-3.83; P = 0.01) while trends showed non-significant rise in liver cirrhosis group from 2007-23. African Americans displayed inflections in mortality trends in Alcoholic Cirrhotic group from 2007-18 with APC of 3.41 (95% CI: 1.79-4.31; P = 0.01) while trends declined non-significantly in Liver cirrhotic group from 2008-23. CENS R3: south (16.29), Micropolitan (14.4) and Texas (21.2) were the highest mean AAMR regions in Liver Cirrhosis group while CENS R4: west (13.83), Large Central Metro (9.68) and New Mexico (15.8) in Alcohol cirrhosis group. Conclusion: Our study highlights notable variations in mortality trends of Alcoholic Cirrhosis group; suggesting the detrimental impact of Alcohol use. Additionally; sharp rising AAMRs till 2035 suggest the utilization of multidisciplinary approach and precise healthcare policies.