S2776 Beyond the Virus: Unveiling the Real-World Mortality Burden of Viral Hepatitis Using CDC WONDER Large Database (1999-2023)

Introduction: Viral hepatitis remains a significant public health challenge worldwide, contributing substantially to liver-related morbidity and mortality in the United States. However, the real-world mortality burden of viral hepatitis is often underestimated due to under-reporting and mis-classification errors on death certificates. Methods: Mortality data from 1999 to 2023 were extracted from the CDC WONDER database. Deaths with International Classification of Diseases, Tenth Revision (ICD-10) codes B15-B19 (viral hepatitis) listed as a multiple cause of death were included. Crude and age-adjusted mortality rates (AAMR) per 100,000 populations were calculated. Joinpoint regression analysis was used to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Results: From 1999-2020, a total of 359,715 deaths were attributed to viral hepatitis. The AAMR itself increased from 3.41 in 1999 to 3.89 in 2020 (AAPC: 0.15, 95% CI: -0.37 to 0.69). The AAMR was significantly higher in men than women (7.00 vs 2.69). Moreover, women had a decreasing trend in mortality (AAPC: -0.32, 95% CI: -0.92 to 0.28) and men had an increasing trend (AAPC: 0.31, 95% CI: -0.20 to 0.83). The crude mortality rate was highest in 55-64 years’ age group (17.90). Among the different ethnic groups, American Indian or Alaska Natives had the highest AAMR (9.26) and the White had the lowest AAMR (4.05). The Hispanic demonstrated the highest decrease in mortality (AAPC: -2.29, 95% CI: -4.11 to -0.45). Geographically, the West had the highest AAMR (6.71) but an overall decreasing mortality trend (AAPC: -0.26, 95% CI: -0.97 to 0.44) and the Northeast had the highest decrease in mortality (AAPC: -1.78, 95% CI: -2.54 to -1.02). Among the states, District of Columbia had the highest AAMR i.e. 12.15 and Wisconsin had the lowest i.e. 2.27. The AAMR was comparable in metropolitan and non-metropolitan regions (4.85 and 4.31), however, over the years, the mortality rate decreased in the metropolitan areas (AAPC: -0.18, 95% CI: -0.71 to 0.34) and increased in non-metropolitan areas (AAPC: 2.24, 95% CI: 1.56 to 2.93). The highest percentage of deaths were reported in inpatient-medical facility (48.66%). Conclusion: Viral hepatitis-related mortality has steadily increased over the past 2 decades, with striking increases in men, 55-64 years of age individuals, American Indians or Alaska Natives, the West, and in rural areas which highlight the need for targeted intervention.