S2887 Exploring the Etiological Spectrum of Liver Cirrhosis Mortality: A Nationwide Analysis Using CDC WONDER (1999-2023)

Introduction: Liver cirrhosis is the 11th leading cause of death globally, driven by multiple etiologies i.e,. viral hepatitis, alcohol, obesity, diabetes, and hepatic neoplasms. Nationwide cirrhosis-related mortality due to these etiologies remained underexplored. This study examines etiological cirrhosis-related mortality trends (1999–2023) in the U.S. population to identify high-risk populations and guide targeted interventions. Methods: Mortality data among adults aged ≥55 spanning 1999-2023 were obtained from the CDC-WONDER database, focusing on deaths due to cirrhosis (ICD 10: K74) with all possible etiologies i.e. viral hepatitis (B15-19), alcoholic liver disease (K70), malignant hepatic and intrahepatic bile duct neoplasms (C22) and Other diseases of liver (K76). Age Adjusted Mortality rates (AAMRs) per 100,000 people were calculated and stratified according to different demographic and geographical variables. The Annual Percentage Change (APC) was calculated using Joinpoint regression with 95% Confidence Interval (CI) and P < 0.05 taken as significant. Results: A total of 38,028 deaths were attributed to Liver Cirrhosis from 1999 to 2023 having an average AAMR of 1.91 with a significant incline from 2018 to 2023, APC: 3.35 (95% CI: 2.09-6.25, P < 0.0001) Mortality among Women increased significantly from 2007-2023 with APC of 3.19 (95% CI: 2.67-3.92; P < 0.0001). Non Hispanics (2006-2023) exhibited a significantly increasing trend with APC: 2.14 (95% CI: 1.60-2.94, P < 0.0001). Among races, during 2019-2023 highest APC in mortality trends was exhibited by American Indians (APC: 8.72, 95% CI: 1.45-26.48, P = 0.01). Mortality trends in Medium Metro (2006-2020), Small Metro (2002-2020) and Noncore (2007-2020) were highest with APC: 2.84 (95% CI: 2.06-4.12, P < 0.0001), 2.50 (95% CI: 1.66-5.12, P = 0.01) and 4.16 (95% CI: 3.07-6.40, P < 0.0001), respectively. Among Census regions, CENS: R2 (Midwest) and CENS: R4 (West) showed consistently increasing mortality trends from 2005 to 2023 with APC of 2.44 (95% CI: 1.70 to 3.82, P < 0.0001) and 2.07 (95% CI: 1.57 to 2.86, P < 0.0001), respectively. Conclusion: Liver cirrhosis mortality in the United States exhibited an initial decline during the first decade followed by a concerning increase especially in women, Non Hispanics, American Indians, and regions like the Midwest and West. These findings highlight the need for targeted interventions addressing specific etiologies leading to cirrhosis.