S2928 Temporal Trends in the Mortality of Cirrhotic Alcohol-Associated Liver Disease in 3 Northern American Countries Over the Past 3 Decades

Introduction: Liver cirrhosis is among the leading causes of global health and socioeconomic burden worldwide in view of the associated morbidity and mortality. Alcohol-Associated Liver Disease (ALD) is widely known as one of the most prevalent causes of cirrhosis. Accordingly, evaluating the temporal trends in the mortality of cirrhotic ALD is of importance as it enables risk stratification and highlights areas requiring intervention. Methods: Data regarding the age-standardized mortality rate (ASMR) of cirrhotic ALD across the U.S., Canada, and Mexico for the period 1990-2019 was retrieved from the Global Burden of Disease database. Temporal trends in the mortality rates were evaluated by calculating the annual percent change (APC) and average annual percent change (AAPC) using Joinpoint analysis software. Stratification by gender was performed to evaluate for potential gender disparities. Results: Over the period 1990-2019, an estimated total of 796,634 deaths due to ALD cirrhosis with a man predominance of 78.9% were reported across the 3 nations. The majority of the deaths were identified in the US (55.8%), followed by Mexico (41.9%) and Canada (2.3%). A statistically significant increase in the ASMR was noted in the US (AAPC 0.40, 95% CI 0.35 to 0.45, P < 0.001). In contrast, a statistically significant decline in the ASMR was noted in Canada (AAPC -0.42, 95% CI -0.50 to -0.29, P < 0.001) and Mexico (AAPC -1.50, 95% CI -1.59 to -1.40, P < 0.001). Gender stratification revealed slight variations across the 3 nations. In Mexico, a statistically significant decline in the ASMR was observed in both men and women, with the latter experiencing a higher level of decline (AAPC -3.15, 95% CI -3.22 to -3.08, P < 0.001). In the US, a statistically significant incline in the ASMR was observed in both men and women, with the latter also experiencing a higher incline (AAPC 0.97, 95% CI 0.92 to 1.03, P < 0.001). In Canada however, a statistically significant decline in the ASMR was noted in men (AAPC -0.60, 95% CI -0.69 to -0.46, P < 0.001) whereas women experienced a statistically nonsignificant increase (AAPC 0.039, 95% CI -0.038 to 0.133, P = 0.3). Conclusion: Over the span of 3 decades, a variation in the mortality trends of cirrhosis due to ALD was observed across the 3 nations, While the US experienced a significant increase in the mortality rates, Canada and Mexico observed a significant decline. These findings require prompt recognition and intervention.