Mortality Trends in Unspecified Gastrointestinal Hemorrhage Co-Recorded with Liver Cirrhosis in U.S. Adults Aged 45 Years and Older, 1999–2024

Background/Objectives: Death certificates provide a population-level measure of mortality involving gastrointestinal hemorrhage (GIH) and liver cirrhosis. We examined trends in deaths with unspecified GIH and selected cirrhosis codes recorded among U.S. adults aged 45 years and older from 1999 through 2024. Methods: Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) mortality data were queried for K92.2 AND (K70.3 OR K74.6). Age-adjusted mortality rates (AAMRs) per 100,000 were standardized to the 2000 U.S. population. Joinpoint models evaluated national trends, alternative model restrictions, an expanded bleeding definition and overlapping cirrhosis-code strata. Results: There were 75,309 deaths, averaging 2897 annually. The mean annual AAMR was 2.27, with higher descriptive means among males and in the West. The primary full-period average annual percent change (AAPC) was 0.48% (95% confidence interval, −0.59 to 1.57; p = 0.381). A maximum-two-joinpoint model was also nonsignificant, whereas wider spacing yielded an AAPC of 1.14% (0.20–2.09; p = 0.018). Adding bleeding esophageal varices identified 105,000 deaths, with an AAPC of 0.26% (−0.52 to 1.05; p = 0.508). Cirrhosis-code analyses were exploratory; the K70.3 model included a three-observation initial segment, limiting interpretation. Conclusions: Mortality with unspecified GIH and selected co-recorded cirrhosis codes represents a defined death certificate endpoint, not all cirrhosis-related bleeding mortality. The identified burden depended on the bleeding codes included, and inference about full-period change and late trends depended on model restrictions.