S2471 Unveiling the Burden: Esophageal Varices Related Mortality in Chronic Liver Disease in the United States (1999–2023)

Introduction: Esophageal varices (OV), a life-threatening complication of portal hypertension in chronic liver disease (CLD), are a major cause of gastrointestinal hemorrhage in older adults. With rising rates of alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease (MASLD), CLD-related complications may be increasing. However, mortality trends specifically linked to CLD and OV among aging populations remain under characterized. This study evaluates national trends and disparities in CLD and OV-related mortality in U.S. adults aged 55+ from 1999 to 2023. Methods: Mortality data from 1999–2023 were extracted from the CDC WONDER database using International Classification of Diseases, Tenth Revision (ICD-10) codes for CLD and OV. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression was used to estimate Annual Percent Change (APC) and Average Annual Percent Change (AAPC), with significance set at P < 0.05. Trends were analyzed across sex, age, race/ethnicity, census region, urbanization level, and state. Results: A total of 38,982 CLD and OV-related deaths occurred in adults aged ≥55, with 59% in inpatient settings. Overall AAMR increased from 2.07 in 1999 to 2.71 in 2023 (AAPC: 1.1%, 95% CI: 0.8–1.6, P < 0.000001). Men had higher mortality than women (2.8 vs 1.2), though women showed a steeper rise (AAPC: 1.4% vs 1.0%). Hispanics had the highest AAMR (3.07), while non-Hispanic (NH) Whites experienced the sharpest increase (AAPC: 1.8%, 95% CI: 1.4–2.2). Notably, NH Asians saw a significant decline (AAPC: –2.0%, 95% CI: –3.1 to –0.3). Adults aged 55–74 had higher mortality than those 75+ (2.25 vs 1.55) and a faster increase (AAPC: 1.59% vs 0.55%). The West had the highest AAMR (2.54), while the South had the fastest growth (AAPC: 1.7%). Rural areas had slightly higher mortality than urban ones (1.96 vs 1.91), with a notably steeper rise (AAPC: 2.3% vs 0.4%). Oregon, Colorado, and New Mexico were among the highest-burden states. Conclusion: CLD and OV-related mortality has risen among older U.S. adults over the past 2 decades. The increase is most pronounced among women, adults aged 55-74, rural residents, and the South region—suggesting gaps in early detection, specialty care, and prevention. These findings underscore the need for improved surveillance, timely variceal screening, and regionally tailored interventions to reduce preventable mortality from CLD-related complications.