S2458 A Look into Regional and Demographic Disparities in Mortality Associated With Portal Hypertension

Introduction: Portal hypertension is increased pressure within the portal venous system. Portal hypertension is the most frequent cause of hospitalization, variceal bleeds, liver transplantation, and death in patients with cirrhosis. This study aims to assess long-term mortality trends and identify regional and demographic disparities among the United States population from 1999-2003. Methods: We analyzed national mortality data using the CDC WONDER database. Deaths were identified using the International Classification of Diseases, Tenth Revision (ICD-10) Code K76.6 (Portal Hypertension). Age-adjusted mortality rates (AAMR) calculated per 1,000,000 individuals were abstracted by sex, race/ethnicity, census region, state and urbanization. Temporal trends were assessed using Joinpoint regression version 5.4. Annual percentage changes (APC) in AAMR were estimated using Monte Carlo Permutation and 95% confidence intervals using the Parametric Method. Results: From 1999 to 2023, mortality trends for portal hypertension showed a steady increase overall across gender, racial groups, and census regions. The age-adjusted mortality rate (AAMR) increased from 4.2 per 1,000,000 in 1999 to 5.8 per 1,000,000 in 2023. Between 1999 and 2023, initial decline in mortality in both men and women was observed. However, a significant upward trend emerged afterwards. In men, mortality increased sharply from 2015 to 2021 (APC +8.31), while women exhibited an even steeper increase from 2018 to 2021 (APC +15.58). Among White individuals, a decline from 1999 to 2001 was noted followed by a rise after 2010, peaking with significant increase from 2018 to 2021 (APC +13.01). In contrast, Black or African American individuals experienced a decline in mortality until 2009 (APC -6.23), followed by a rise through 2023 (APC +1.32). South has the highest mortality from 2013-2023 (APC +7.24) with an initial decline from 1999-2003 (APC –6.34) followed by West from 2009-2023 (APC +5.93). The Northeast and Midwest both experienced substantial declines from 1999-2012 (APC –2.88 and –1.92 respectively), followed by a rise in 2023 (APC +4.30 and +5.94 respectively). Among states, the highest average AAMRs were recorded in the Dakotas while the lowest were seen in Louisiana and Mississippi. Conclusion: Between 1999 and 2023, mortality from portal hypertension in the U.S. increased overall. Further research should be conducted to help determine what factors helped with initial decline in mortality trends unanimously.