S2621 Impact of Comorbid Diabetes on Chronic Liver Disease Mortality in US Adults Aged 55 and Older: A 25-Year Nationwide Analysis

Introduction: Chronic liver disease (CLD) in patients with diabetes is a growing public health concern in the United States, particularly among older adults. Hyperglycemia contributes to hepatic inflammation and fibrosis, accelerating liver dysfunction and increasing the risk of cirrhosis and liver-related mortality. These conditions commonly coexist and pose significant challenges in management due to overlapping pathophysiology and complex clinical trajectories. This study assesses long-term mortality trends and demographic disparities in CLD-related deaths among U.S. adults aged ≥55 with diabetes from 1999 to 2023. Methods: Mortality data was extracted from CDC WONDER using International Classification of Diseases, Tenth Revision (ICD-10) codes for CLD and diabetes among adults aged 55 and older. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Trends were stratified by sex, age, race/ethnicity, region, urbanization, and state. Joinpoint regression estimated the average annual percent change (AAPC) with 95% confidence intervals (CI). Significance was defined as P < 0.05. Results: From 1999 to 2023, 148,072 deaths were attributed to CLD in individuals with diabetes. The overall AAMR more than doubled, rising from 5.17 to 11.84 per 100,000 (AAPC: 3.45; 95% CI: 3.22–3.66; P < 0.000001). Men had higher mortality than women (AAMR: 9.12 vs 5.73) and a steeper upward trend (AAPC: 3.76 vs 2.95, both P < 0.000001). Non-Hispanic (NH) American Indian/Alaskan Native individuals had the highest AAMR (21.4), followed by Hispanic populations (15.0), while NH Whites showed the sharpest rise (AAPC: 3.74), closely followed by NH American Indians (AAPC: 2.99). Regionally, the South had the steepest increase (AAPC: 4.13), followed by the West (AAPC: 3.33), both P < 0.000001. States with the highest AAMRs included Oklahoma (12.27), Texas (11.35), and Kentucky (10.68). Rural areas had higher mortality (AAMR: 7.41 vs 6.49) and faster growth (AAPC: 4.57 vs 3.14) as compared to urban areas. Adults aged ≥75 had a greater mortality burden and higher AAPC (3.93 vs 3.30). Conclusion: Mortality due to CLD among older adults with diabetes has more than doubled over the past 25 years, with pronounced increases in men, NH White, the South region, and rural areas. These findings underscore the urgent need for targeted interventions and equitable access to preventive care and liver disease management in high-risk groups.