S2810 Trends and Disparities in Liver Disease and Renal Failure-Related Mortality in Adults ≥65 Years From 1999 to 2023 in the United States

Introduction: Liver disease (LD) and renal failure (RF) are interrelated, as their concurrence is associated with dire outcomes and accelerated mortality. Cirrhosis can precipitate RF, as in hepatorenal syndrome, while RF may also exacerbate hepatic dysfunction. Research on LD and RF-related mortality trends stratified by demographic and regional factors in the United States remains limited. This study analyzes national LD and RF-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 LD (K70-K76) and RF (N17-N19). Data were stratified by year, demographic, and geographic classifications. Age-adjusted mortality rates (AAMR) were calculated 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 185,827 LD and RF-related deaths occurred from 1999 to 2023. Overall, AAMR rose from 15.2 in 1999 to 23.3 in 2023 (AAPC: 1.9; 95% CI: 1.1 to 2.6). Men, in comparison to women, had higher average AAMR, while women had a higher rate of increase (AAPC: 2.1679; 95% CI: 1.4 to 3.0). In terms of age groups, adults aged 75-84 years had the highest average CMR, while adults ≥85 years had the highest rate of increase (AAPC: 2.1; 95% CI: 1.2 to 3.0). Racially, non-Hispanic (NH) American Indian/Alaska Natives had the highest average AAMR, but had stable rates along with Hispanic/Latinos. NH Whites and NH Black/African Americans had increasing rates, while NH Asian/Pacific Islanders experienced decreasing rates (AAPC NH White: 1.9; 95% CI: 1.3 to 2.6, NH Black/African American: 1.3; 95% CI: 0.7 to 1.9, NH Asian/Pacific Islander: -1.2; 95% CI: -2.3 to -0.1). Regionally, the West had the highest average AAMR, along with the highest rate of increase (AAPC: 2.0; 95% CI: 1.1 to 2.8). From 1999 to 2020, rural areas, in comparison to urban areas, had higher average AAMR, but both had stable rates. Conclusion: LD and RF-related mortality among adults ≥65 years increased significantly from 1999 to 2023, with marked disparities across demographic and geographic groups. These disparities underscore the urgency for targeted interventions and policy reforms to decrease mortality rates in high-risk demographics.