University of Pennsylvania Health System Philadelphia, PA
Fariha Hasan, MD1, Mariam Shahabi, MBBS2, Kinza Khan, MD3, Aizaz Ali, MBBS4, Daniel Guirguis, MD, MS5, Hareesha Rishab Bharadwaj, 6, Avneet Singh, DO1, Polina Gaisinskaya, MD7, Dushyant S. Dahiya, MD8, Sheza Malik, MD9, Shahid Malik, MD10 1Cooper University Hospital, Camden, NJ; 2Dow Medical College, Karachi, Sindh, Pakistan; 3University of Pennsylvania Health System, Philadelphia, PA; 4Khyber Medical college, Peshawar, Mardan, North-West Frontier, Pakistan; 5St. Luke's University Hospital, Hatfield, PA; 6The University of Manchester, Manchester, England, United Kingdom; 7Cooper Health Gastroenterology, Camden, NJ; 8University of Kansas School of Medicine, Kansas City, KS; 9Emory University, Atlanta, GA; 10Lehigh Valley Health Network, Allentown, PA Introduction: Chronic liver disease (CLD) is a major global health burden, and its overlap with diabetes is drawing growing attention due to shared pathophysiology. The rising prevalence of type 2 diabetes parallels increases in obesity and metabolic syndrome-key contributors to metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH). However, there is a lack of population-level data on the mortality burden associated with concurrent CLD and diabetes. In this study, we describe temporal and demographic patterns in CLD and diabetes deaths in the United States from 1999 to 2020. Methods: The CDC WONDER database was queried for records listing diabetes mellitus and CLD as underlying or contributing causes of death. Adults aged 25 years and above were included, and data were grouped by year, gender, race, and region. Age-adjusted mortality rates (AAMR) were calculated per 100,000 individuals. Joinpoint regression was used to calculate annual percent change (APC) and average annual percent change (AAPC) in AAMRs from 1999 to 2020. Results: Between 1999 and 2020, there were 75,883 deaths due to CLD and diabetes in the U.S. The AAMR increased from 0.71 in 1999 to 2.44 in 2020 (AAPC: 6.02, 95% CI: 5.51 to 6.53). A parallel trend was observed in males (AAPC: 5.91, 95% CI: 5.37 to 6.45) and females (5.68, 95% CI: 4.62 to 5.36), with males experiencing consistently higher AAMRs throughout the study period (overall AAMR males: 2.22; females: 0.92). Non-Hispanic American Indians/Alaska Natives had the highest AAMRs (overall AAMR: 5.39) and experienced the steepest overall increase in mortality until 2020 (AAPC: 6.78, 95% CI: 5.63 to 7.94), compared with other races. Urban regions had higher AAMRs (overall AAMR urban: 0.25; rural: 0.12) but experienced a significant decline in mortality from 1999 to 2020 (AAPC: -3.51, 95% CI: -4.56 to -2.45). Visual trends are illustrated in Figure 1. Discussion: From 1999 to 2020, CLD and diabetes mortality rose across most U.S. groups, with the sharpest increase and highest AAMRs in non-HispanicAmerican Indians/Alaska Natives individuals. Prior studies show higher diabetes and liver disease mortality in this population, likely due to systemic healthcare barriers. Broad behavioral and policy efforts are needed to reduce these disparities.
Figure: Figure1. National trends in age-adjusted mortality from chronic liver disease and diabetes between 1999 and 2020 across key demographic groups.
Disclosures: Fariha Hasan indicated no relevant financial relationships. Mariam Shahabi indicated no relevant financial relationships. Kinza Khan indicated no relevant financial relationships. Aizaz Ali indicated no relevant financial relationships. Daniel Guirguis indicated no relevant financial relationships. Hareesha Rishab Bharadwaj indicated no relevant financial relationships. Avneet Singh indicated no relevant financial relationships. Polina Gaisinskaya indicated no relevant financial relationships. Dushyant Dahiya indicated no relevant financial relationships. Sheza Malik indicated no relevant financial relationships. Shahid Malik indicated no relevant financial relationships.
Fariha Hasan, MD1, Mariam Shahabi, MBBS2, Kinza Khan, MD3, Aizaz Ali, MBBS4, Daniel Guirguis, MD, MS5, Hareesha Rishab Bharadwaj, 6, Avneet Singh, DO1, Polina Gaisinskaya, MD7, Dushyant S. Dahiya, MD8, Sheza Malik, MD9, Shahid Malik, MD10. P3767 - Rising Mortality Due to Chronic Liver Disease and Diabetes in American Indians/Alaska Natives: A 1999-2020 Nationwide Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
