S2708 Mortality Patterns in Hepatic Cirrhosis and Chronic Kidney Disease: A US Population-Based Study (1999-2020)

Introduction: Hepatic cirrhosis and chronic kidney disease (CKD) frequently coexist, with each condition aggravating the other through shared inflammatory and hemodynamic mechanisms. In cirrhosis, portal hypertension compromises renal perfusion, heightening the risk of CKD. This study investigates annual mortality trends and demographic disparities associated with cirrhosis and CKD in the U.S. population from 1999 to 2020. Methods: We analyzed cirrhosis-associated CKD-related mortality trends in the U.S. from 1999 to 2020 using the CDC WONDER Multiple Cause of Death database. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Temporal trends and annual percent changes (APCs) were evaluated overall and further stratified by sex, race/ethnicity, urban-rural classification, and U.S. census regions. Results: Our analysis suggests that from 1999 to 2020, 45,471 cirrhosis-associated CKD-related deaths occurred among U.S. adults. The age-adjusted mortality rate (AAMR) increased from 0.27 to 1.14 per 100,000, with an annual percent change (APC) of 6.84% (95% CI: 6.05–7.98, P < 0.000001). Men had a higher AAMR (0.81) than women (0.42). Non-Hispanic American Indian or Alaska Natives had the highest AAMR (1.73), followed by Hispanics (1.2). Regionally, the West reported the highest AAMR (0.7). Metropolitan areas had higher rates (0.6) than non-metropolitan areas (0.5). Conclusion: Over the past 2 decades, mortality related to cirrhosis-associated chronic kidney disease (CKD) has steadily increased across the United States, highlighting significant disparities based on sex, race/ethnicity, and geographic location. The most substantial impact has been observed among non-Hispanic American Indian or Alaska Native populations, as well as individuals residing in the Western region. These disparities emphasize the urgent need for targeted public health initiatives aimed at reducing preventable deaths and promoting health equity among the groups that are disproportionately affected.