S2516 Trends and Disparities in Liver Cirrhosis and Diabetes Mellitus Related Mortality in the United States From 1999 to 2020: A 22-Year Analysis

Introduction: Diabetes mellitus (DM) and liver cirrhosis are frequently comorbid, with glucose intolerance present in up to 96% of cirrhotic patients and overt DM in 30%. This study aimed to assess national trends and disparities in cirrhosis and DM-related mortality among adults in the U.S. Methods: Mortality data for adults aged ≥25 years from 1999 to 2020 were extracted from the CDC WONDER database using International Classification of Diseases, Tenth Revision (ICD-10) codes for cirrhosis and DM. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Trends were evaluated using Joinpoint regression to estimate annual percent changes (APCs), stratified by sex, age, race/ethnicity, geography, and urbanization. Results: A total of 90,378 deaths were identified. National AAMRs increased from 1.58 in 1999 to 2.75 in 2020, with the steepest rise between 2018 and 2020 (APC: 14.09). Men had higher mortality (AAMR: 2.24) than women (1.52). Adults ≥65 years had a significantly higher CMR (6.02) compared to those aged 25–64 years (0.97). NH American Indians exhibited the highest AAMR (5.19), while NH Blacks (1.54) and NH Asians (1.31) had the lowest. Regional disparities showed the South (2.07) and West (2.06) had the highest AAMRs, followed by the Midwest (1.68) and Northeast (1.42). Nonmetropolitan areas (2.14) had higher mortality than metropolitan areas (1.81). State-level AAMRs ranged from a high in Oklahoma (3.49) and Texas (3.39) to a low in Alaska (1.16) and Nevada (1.01). States in the top 10th percentile had mortality rates 3 times higher than those in the bottom 10th percentile. Conclusion: Cirrhosis and DM-related mortality has steadily increased since 2010, with the sharpest acceleration post-2018. The most affected groups include men, older adults, NH American Indians, and residents of the South, West, and rural areas. Public health efforts should prioritize these high-risk populations to address rising mortality and health disparities.