S2897 Evaluating the Temporal Trends in Mortality Due to Liver Cirrhosis Versus Cirrhosis With Ascites: A Retrospective Analysis From CDC-WONDER and ARIMA Model

Introduction: Liver Cirrhosis is the leading cause of mortality in middle-aged Americans, with even worse outcomes when effected with Ascites. This study seeks to evaluate the comparative mortality trends in Liver Cirrhosis as a single cause of death vs Liver Cirrhosis with comorbid Ascites from 1999-2023. Methods: A retrospective analysis was conducted using CDC Wonder database (1999 to 2023). Individuals aged ≥45 years with liver cirrhosis (International Classification of Diseases, Tenth Revision [ICD-10] K74) and Liver cirrhosis with underlying ascites (ICD-10 K74 + R18) were analyzed. Age-adjusted mortality rates (AAMRs) per 100,000 were stratified across year, gender, race/ethnicity, urbanization, region, and state. Annual percentage changes (APCs) were assessed using Bayesian information Criterion (BIC) approach in joinpoint regression (JPR) analysis, with P-value set at <0.05. An autoregressive integrated moving average (ARIMA) model was applied to forecast mortality trends from 2024 to 2030 which was validated through Ljung-box test. Results: Liver cirrhosis accounted for 411,182 deaths with overall AAMR of 13.24 which is forecasted to reach 14.5 (95% CI: 12.62-16.37; Ljung-box test P-value = 0.177) till 2030. Death toll due to cirrhosis complicated with Ascites was 17,448 with AAMR of 0.56 (predicted as 1.25 till 2030). Men (1999-2009), non-Hispanics (1999-2008) and African Americans (1999-2008) exhibited significant deflection in mortality trends of Liver cirrhosis with APC of -1.21 (95% CI: -1.89 to -0.57; P = 0.02), -1.20 (-2.11 to -0.58; P = 0.00) and -2.42 (95% CI: -5.45 to -1.24; P = 0.00), respectively. However, in Ascites group, sharp rise was observed in Hispanics (2008-23), Male (2010-23) and whites (2011-23) with APC of 3.57 (95% CI: 2.28-8.69; P = 0.00), 4.92 (95% CI: 4.17-6.01; P = 0.00) and 6.19 (95% CI: 4.75-8.59; P = 0.00), respectively. CENS R3: south (mean AAMR = 16.29) and Texas (21.2) were the predominant regions in Liver Cirrhosis while CENS R3: south (mean AAMR = 0.64) and west Virginia (0.9) displayed highest AAMRs in ascites complicated liver cirrhosis. Conclusion: Mortality fluctuated several times in both comparison groups for the whole study period, specifically substantial rise in Ascites complicated Liver Cirrhosis in recent years. These rising trends in men and whites provide pertinent insights about cirrhotic patients with ascites. Strengthened preventive measures and implications of subtle healthcare policies are needed to latch existing gaps.