Trends and disparities in fall-related mortality among individuals with cirrhosis in the United States, 1999 to 2023

Falls are common and clinically consequential in cirrhosis, but national population-level trends in deaths for which a fall is recorded as the underlying cause and cirrhosis as a contributing cause are poorly characterized. This study examined long-term mortality trends and demographic and geographic disparities in the United States from 1999 through 2023. Using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research multiple cause of death data, we identified adults aged ≥45 years with a fall (International Classification of Diseases, 10th revision W00–W19) as the underlying cause of death and cirrhosis or advanced cirrhosis-related diagnoses (K70.2, K70.3, K71.7, K72.1, K72.9, K74.0, K74.1, K74.2, K74.6, K76.6, K76.7, or I85) as contributing causes. Age-adjusted mortality rates (AAMRs) per 1,000,000 persons were calculated using the general U.S. population as the denominator. Joinpoint regression estimated annual percent changes (APCs). Analyses were stratified by sex, age, Hispanic origin, census region, state, urbanization, and place of death. A sensitivity analysis restricted cirrhosis to K70.3 and K74.6. A total of 10,029 deaths met the primary definition. The overall AAMR increased from 1.5 in 1999 to 5.5 in 2023. Joinpoint regression identified an increase from 1999 to 2017 (APC, 4.65%; 95% CI, 1.57–9.34; P = .029) followed by a steeper increase from 2017 to 2023 (APC, 7.29%; 95% CI, 5.08–13.36; P = .004). In 2023, AAMRs were higher in men than women (7.31 vs 4.02) and in adults aged ≥65 years than those aged 45 to 64 years (9.28 vs 3.40). The West had the highest regional AAMR in 2023 (6.60). Medical facilities accounted for 67.1% of deaths in 2023. The restrictive-code sensitivity analysis identified 9307 deaths and showed a similar increase in AAMR from 1.4 to 5.3, with APCs of 4.92% (1999–2017) and 7.90% (2017–2023). Population-level mortality involving a fall as the underlying cause and cirrhosis as a contributing cause increased substantially from 1999 to 2023, with important demographic and geographic differences. These findings quantify national burden but do not estimate the individual risk of fall-related death among people living with cirrhosis and do not establish causal mechanisms. They support further evaluation of fall-risk and frailty assessment and prevention strategies in cirrhosis, particularly in older and higher-burden populations.