S2812 Trends and Disparities in Mortality Related to Fibrosis and Cirrhosis of the Liver Along With Sepsis in Adults ≥65 Years From 1999 to 2023 in the United States

Introduction: Fibrosis and cirrhosis of the liver are bidirectionally linked with sepsis, with their coexistence leading to worse outcomes and higher mortality. Sepsis promotes hepatic injury through inflammation, dysbiosis, and hepatocyte damage, while cirrhosis and fibrosis worsen sepsis via immune dysfunction and impaired liver reserve. This study analyzes national liver fibrosis/cirrhosis and sepsis-related mortality trends among adults ≥65 years from 1999 to 2023. Methods: The CDC WONDER Multiple-Cause-of-Death dataset (1999–2023) was used to assess mortality trends among adults ≥65 years using International Classification of Diseases, Tenth Revision (ICD-10) codes for liver fibrosis/cirrhosis (K74) and sepsis (A02.1, A22.7, A26.7, A32.7, A40, A41, A42.7, B37.7). Data were stratified by year, demographic, and geographic classifications. Age-adjusted mortality rates (AAMR) were quantified per 100,000 persons by standardizing crude mortality rates (CMR) with 95% confidence intervals (95% CI). Average annual percent change (AAPC) was calculated via the Joinpoint regression model, with statistical significance defined as P < 0.05. Results: A total of 47,586 liver fibrosis/cirrhosis and sepsis-related deaths occurred from 1999 to 2023. Overall AAMRs rose from 3.0 in 1999 to 6.8 in 2023 (AAPC: 3.7; 95% CI: 3.4 to 4.1). Men had higher average AAMR compared to women, while women had a higher rate of increase (AAPC: 3.9; 95% CI: 3.5 to 4.3). In terms of age groups, adults aged 65-74 years had the highest average CMR, though adults ≥85 years had the highest rate of increase (AAPC: 4.7; 95% CI: 4.0 to 5.5). Racially, Hispanic/Latinos had the highest average AAMR, and non-Hispanic Whites had the highest rate of increase (AAPC: 3.7; 95% CI: 3.5 to 4.1). Southern regions had the highest average AAMR, and along with Northeastern regions, had declining rates (AAPC Northeast: -3.2; 95% CI: -4.1 to -2.1, AAPC South: -1.5; 95%CI: -4.7 to -0.6) compared to stable rates for Western and Midwestern regions. From 1999 to 2020, urban areas had higher average AAMR, while rural areas had a higher rate of increase (AAPC: 4.6; 95%CI: 3.8 to 5.8). Conclusion: Liver fibrosis/cirrhosis and sepsis-related mortality rates among adults ≥65 years increased significantly from 1999 to 2023, with key disparities across demographic and geographical classifications. These disparities highlight the need for targeted interventions in high-risk populations so that mortality rates can decrease in the future.