S2771 National Mortality Trends in Decompensated Cirrhosis (1999–2023) and Forecast to 2030: A CDC WONDER-Based ARIMA Analysis

Introduction: Decompensated cirrhosis (DC) causes 55,000 liver-related deaths annually in the U.S., with a mortality rate of 85%. We hypothesized that significant disparities in mortality trends exist across sociodemographic groups. This study analyzed national DC-related mortality trends from 1999 to 2023 and projected rates through 2030. Methods: We analyzed CDC WONDER data on DC-related deaths using International Classification of Diseases, Tenth Revision (ICD-10) codes K70.31, R17, I85.01, I86.4, K72.90–K72.91, R18.8, and K74.60–K74.69. Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, age, race/ethnicity, and census region. Temporal trends were evaluated using Joinpoint regression to estimate annual percentage changes (APCs). ARIMA models with Box-Cox transformation were fitted after ADF/KPSS tests, with validation by residual checks. Results: Between 1999-2023, DC accounted for 1,801,091 deaths in the United States, with mortality trends demonstrating 4 distinct phases: an initial decline (1999-2009; APC -1.36%, P < 0.001), followed by gradual increases (2009-2018; APC +1.24%, P < 0.001), a dramatic pandemic-era surge (2018-2021; APC +7.43%, P < 0.001), and a recent modest decline (2021-2023; APC -3.54%, P = 0.022). Significant disparities emerged across demographic groups, with men and younger adults (25-44 years) experiencing the most pronounced increases during 2018-2021 (APC +20.84%, P = 0.000007). Geographic variations were evident, with the West and South experiencing the most significant pandemic surges. Racial/ethnic disparities were particularly striking, as American Indian/Alaska Native populations reached peak mortality in 2021 (AAMR 157.14) before showing a significant decline (APC -12.70%, P < 0.001), while White and Hispanic populations sustained substantial increases. Asian/Pacific Islander groups maintained the lowest mortality rates throughout the study period. Projections indicate a gradual 6% decline in age-adjusted mortality rates by 2030, decreasing from 31.44 (95% CI 30.68-32.25) in 2024 to 29.57 (95% CI 28.09-31.20) in 2030. Conclusion: Decompensated cirrhosis mortality showed dynamic trends, with a concerning pandemic surge and persistent disparities among men, young adults, and American Indian/Alaska Native populations. While recent declines and projected trends are encouraging, targeted interventions for high-risk groups remain critical to address ongoing inequities in liver disease outcomes.