S2909 Nationwide Trends and Inequities in Hepatorenal Syndrome Mortality in the United States: A 24-Year Population-Based Study (1999-2022)

Introduction: Hepatorenal syndrome (HRS) is a life-threatening complication of advanced liver disease, resulting in progressive renal dysfunction and poor clinical outcomes. Despite advancements in liver disease management, HRS continues to carry high morbidity and mortality. However, long-term national trends and sociodemographic disparities in HRS-related mortality remain relatively understudied. Methods: We conducted a population-based analysis using data from the CDC WONDER database from 1999 to 2022, identifying HRS-related deaths in U.S. adults via International Classification of Diseases, Tenth Revision (ICD-10) code K76.7. Age-adjusted mortality rates (AAMRs) were calculated and stratified by age, sex, race/ethnicity and geographic location. Joinpoint regression was used to evaluate temporal trends, reporting annual percent changes (APCs) with 95% confidence intervals. Statistical significance was defined as P < 0.05. Results: A total of 107,615 U.S. adults died from HRS between 1999 and 2022, with 75% deaths reported in the medical facilities. The overall AAMR per 100,000 declined significantly from 2.43 in 1999 to 1.83 in 2008 (APC: –3.44; P < 0.01), followed by a non-significant increase to 1.90 in 2018 (APC: 0.52; P = 0.35), and then a significant rise to 2.33 by 2022 (APC: 6.90; P < 0.01). Men consistently exhibited higher AAMRs than women (2.78 vs 1.38). While older adults had the highest overall AAMR (3.97), younger adults experienced the sharpest increase from 2017 to 2022 (APC: 15.92; P < 0.01). Racial disparities were evident, with the highest AAMRs observed among non-Hispanic (NH) American Indian or Alaska Native individuals (8.34), followed by Hispanic (2.94), NH White (1.97), NH Black (1.84), and NH Asian or Pacific Islander (1.11) groups. Non-metropolitan areas had higher AAMRs (2.44) than metropolitan areas (1.91). Regionally, the West reported the highest overall AAMR (2.62) while lowest one was noted in Midwest (1.73). State level analysis revealed highest death rates in New Mexico (7.16) followed by Wyoming (6.56). Conclusion: These findings reveal a concerning resurgence in HRS mortality in recent years, reversing earlier declines. The highest AAMRs were observed among NH American Indian or Alaska Native individuals, men, older adults, and residents of non-metropolitan and Western regions. These disparities urgently call for equity-focused interventions, improved access to specialized liver and renal care, and culturally tailored strategies to reduce the growing burden of HRS among vulnerable populations.