P5936 - Trends and Disparities in Mortality From Esophageal Variceal Hemorrhage Among Adults With Cirrhosis in the United States, 1999–2020: A Retrospective Analysis

Usman Mazhar, MBBS¹, Hafsah Ali, MBBS², Ali Hamza, MBBS³, Muhammad Hamza Rafique, MD⁴, Muhammad Khizer Azeem, MBBS⁵, Maham Waqar, MBBS⁵, Allah Dad, MD⁶, Anmol Batra, MBBS⁷, Fnu Veena, MD⁸, Abdullah Farooq, MBBS⁹, Ibrar Atiq, MD¹⁰
1Rawalpindi Medical University, Pakistan, Rawalpindi, Punjab, Pakistan; 2Allama Iqbal Medical College, Manama, Al Muharraq, Bahrain; 3Army Medical College, Rawalpindi, Punjab, Pakistan; 4Woodhull Medical Center, Brooklyn, NY; 5Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan; 6Shiekh Zayed Medical College Rahim Yar Khan, Pakistan, Kot Addu, Punjab, Pakistan; 7Ghulam Muhammad Mahar Medical College, Sadiqabad, Punjab, Pakistan; 8BronxCare Health System, Bronx, NY; 9Allama Iqbal Medical College, Rawalakot, Azad Kashmir, Pakistan; 10United Health Services, Wilson Medical Center, Johnson City, NY

Introduction: Esophageal variceal hemorrhage (EVH) is a life-threatening complication of cirrhosis, increasingly affecting younger populations due to rising burden of Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) and alcohol-related liver disease (ALD). Despite therapeutic advances, national trends and demographic disparities in EVH-related mortality remain undercharacterized.

Methods: Using CDC WONDER multiple cause-of-death data (1999–2020), we identified adult deaths (≥25 years) listing alcoholic and nonalcoholic cirrhosis (ICD-10: K70.3, K74.0–K74.6) and esophageal varices with bleeding (I85.01). Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. Joinpoint regression assessed annual percent changes (APCs), stratified by age, sex, race/ethnicity, region, and urbanization.

Results: A total of 29,434 EVH-related deaths were identified. Overall AAMR declined from 5.8 in 1999 to 4.2 in 2006 (APC 2001-2006: –11.25%, 95% CI: –15.62 to –6.66, p < 0.001), then increased significantly to 7.4 by 2020 (APC: +2.87%, 95% CI: +2.05 to +3.69, p < 0.001).
Middle-aged adults (45–64 years) accounted for 61% of deaths (n=18,415), with AAMRs rising from 7.2 in 2006 to 11.9 in 2020 (APC: +12.49% CI: –11.21 to +42.52, 2006–2009; +0.73% CI: –0.78 to +2.25, 2009–2020). Among young adults (25–44 years), AAMR declined from 3.3 in 2001 to 1.5 in 2006 (APC: –15.16%, 95% CI: –24.23 to –5.08, p = 0.008), followed by a rise to 2.3 in 2018 (APC: +2.63%, 95% CI: +0.25 to +5.08; p = 0.033), and a spike to 3.5 in 2020.

By 2020, AAMRs were higher in males 10.9 than females 4 and highest among American Indian/Alaska Native 31.4, followed by Hispanic 12.3, non-Hispanic (NH) Whites 6.9, and NH Black individuals 5.6. Rates were highest in the West (8.6), followed by South 6, Midwest 5.2, and Northeast 5.1. Non-metropolitan areas showed higher rates 6.4 compared to metropolitan areas 6.2. Rising trends were evident across nearly all stratified subgroups after 2006.

Discussion: EVH-related mortality is increasing in U.S. adults with cirrhosis, especially among middle-aged and younger populations with 18,415 of 29,434 deaths. Addressing this trend requires a layered public health response. Broadly, efforts must focus on reducing the upstream burden of MASLD and ALD through prevention and early detection. Specifically, strategies should include expanded MASLD screening, routine fibrosis assessment in primary care, improved access to alcohol cessation services and targeted cirrhosis surveillance.


Figure: Figure 1: Trends and Disparities in Mortality from Esophageal Variceal Hemorrhage Among Adults with Cirrhosis in the United States, 1999–2020: A Retrospective Analysis

Disclosures:
Usman Mazhar indicated no relevant financial relationships.
Hafsah Ali indicated no relevant financial relationships.
Ali Hamza indicated no relevant financial relationships.
Muhammad Hamza Rafique indicated no relevant financial relationships.
Muhammad Khizer Azeem indicated no relevant financial relationships.
Maham Waqar indicated no relevant financial relationships.
Allah Dad indicated no relevant financial relationships.
Anmol Batra indicated no relevant financial relationships.
Fnu Veena indicated no relevant financial relationships.
Abdullah Farooq indicated no relevant financial relationships.
Ibrar Atiq indicated no relevant financial relationships.

Usman Mazhar, MBBS¹, Hafsah Ali, MBBS², Ali Hamza, MBBS³, Muhammad Hamza Rafique, MD⁴, Muhammad Khizer Azeem, MBBS⁵, Maham Waqar, MBBS⁵, Allah Dad, MD⁶, Anmol Batra, MBBS⁷, Fnu Veena, MD⁸, Abdullah Farooq, MBBS⁹, Ibrar Atiq, MD¹⁰. P5936 - Trends and Disparities in Mortality From Esophageal Variceal Hemorrhage Among Adults With Cirrhosis in the United States, 1999–2020: A Retrospective Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.