S2514 Mortality Trends of Hepatorenal Syndrome in Older Adults in the United States: A Retrospective Analysis From 1999 to 2023

Introduction: Hepatorenal syndrome (HRS) is a fatal complication of liver cirrhosis with high mortality, particularly in advanced stages. While clinical factors influencing mortality are studied, demographic impacts remain poorly understood. This study analyzes HRS mortality trends by age, sex, race/ethnicity, and region in the U.S. Methods: CDC-WONDER data from 1999–2023 was used for individuals aged 45+ with HRS (International Classification of Diseases, Tenth Revision (ICD-10) K76.7) as the primary cause of death. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 1 million were calculated. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC). Results: From 1999–2020, there were 85,348 deaths (AAMR: 32.35). AAMR dropped from 39.28 (1999) to 30.18 (2007), stabilized until 2018 (29.98), and rose to 34.69 in 2020 (APC: 5.99), showing an overall decline (AAPC: -0.79). Sex Disparities: Men had 64.3% of deaths, with AAMR of 44.45 vs 21.43 in women. Male AAMR fell from 56.29 (1999) to 45.61 (2020), while woman AAMR declined (24.94 to 19.22) until 2007, then rose to 25.03 in 2020, especially post-2018 (APC: 6.91). Racial/Ethnic Disparities: NH Whites had most deaths (72.49%), followed by Hispanics (13.08%) and NH Blacks (9.92%). Highest AAMRs: NH American Indians (94.82), Hispanics (46.98), NH Whites (30.98), NH Blacks (30.61), NH Asians (17.81). Age Trends: Highest death share: ages 55–64 (31.84%), 45–54 (25.73%), 65–74 (23.72%). Highest CMRs: ages 75–84 (41.08), 65–74 (39.66), 55–64 (35.35). 2021–2023 Trends: 15,662 deaths (AAMR: 35.52). AAMR peaked at 37.37 in 2021, then declined (2023: 33.94). Men: 9,573 deaths (AAMR: 45.73); women: 6,089 deaths (AAMR: 26.31). NH AI had highest AAMR (145.20), followed by Hispanics (42.30), NH Whites (37.31), NH Blacks (24.18), NH Asians (13.90). Highest state AAMR: Alaska (pre-2020, 58.04); North Dakota (2021–2023, 83.68). Conclusion: HRS mortality shows stark disparities by sex, age, ethnicity, and region. While men and NH American Indians remain most affected, mortality has increased among women, NH Whites, and middle-aged adults, highlighting the need for focused public health strategies.