P5863 - Comparative Analysis and Forecasting of Nationwide Mortality Trends in Liver Cirrhosis vs Alcoholic Cirrhosis of Liver in the US Population Using CDC Wonder Database (1999-2023) and ARIMA Model

Arbaz Hassan, MBBS¹, Usman Afzal, MD², Muhammad Saim, MBBS³, Ahmad Sarim Aziz, MBBS⁴, Anfal Hamza, MBBS¹, Talha Sajjad, MBBS, MD¹, Faiza Naz, MBBS⁵, Tehreem Rao, MBBS⁶, Areeba Aamir Ali Basaria, ⁶, Atif Nawaz Malik, MBBS¹, Farah Shehryar, MBBS⁷
1Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan, Rahim Yar Khan, Punjab, Pakistan; 2MedStar Health, Washington, D.C., DC; 3Seikh Zayed Medical College Rahim Yar Khan, Rahim Yar Khan, Punjab, Pakistan; 4Azra Naheed Medical College, Lahore, Pakistan, Lahore, Punjab, Pakistan; 5Sheikh, Rahim Yar Khan, Punjab, Pakistan; 6Dow University of Health Sciences, Karachi, Sindh, Pakistan; 7Khyber Medical College, Peshawar, Pakistan, Peshawar, Sindh, Pakistan

Introduction: In 2023, an estimated 2 million adults in the United States were affected by cirrhosis highlighting the sustained burden of liver disease, particularly the alcohol-induced cases. This study aims to provide a comparative analysis of mortality trends in overall liver cirrhosis and alcoholic liver cirrhosis in the U.S population from 1999 to 2023.

Methods: This epidemiological study was conducted using data sourced from CDC WONDER database (1999-2023). We calculated age- adjusted mortality rate (AAMR) per 100,000 population in several demographic and geographic variables for a comparative analysis between liver cirrhosis(k-74) and alcohol-induced liver cirrhosis(k-70.3) in adults aged >45 years. Annual percentage changes (APCs) were assessed using Monte-carlo permutation test in Joinpoint regression (JPR) analysis. An autoregressive integrated moving average (ARIMA) approach was employed to forecast AAMRs from 2024 to 2035, which was validated through Ljung-box test.

Results: From 1999-2023, Liver Cirrhosis accounted for 441,182 deaths with mean AAMR of 13.24 (14.5 till 2035; Ljung-box test p-value= 0.177). While 284,920 deaths occurred due to Alcoholic Cirrhosis of liver with rising AAMR of 6.3 in 1999 and 13.0 in 2023 (16.14 till 2035; Ljung-box test p-value= 0.604). Male (1999-2009) showed non-significant rise in liver cirrhosis mortality in contrast to significant decline in mortality rate due to Alcoholic Cirrhosis with APC of -1.21 (95% CI: -1.89 to -0.57; p= 0.02). Hispanics exhibited a notable rise in alcoholic cirrhotic mortality from 2004-23 with APC of 2.17 (95% CI: 1.76-3.83; p=0.01) while trends showed non-significant rise in liver cirrhosis group from 2007-23. African Americans displayed inflections in mortality trends in Alcoholic Cirrhotic group from 2007-18 with APC of 3.41 (95% CI: 1.79-4.31; p=0.01) while trends declined non-significantly in Liver cirrhotic group from 2008-23. CENS R3: south (16.29), Micropolitan (14.4) and Texas (21.2) were the highest mean AAMR regions in Liver Cirrhosis group while CENS R4: west (13.83), Large Central Metro (9.68) and New Mexico (15.8) in Alcohol cirrhosis group.

Discussion: Our study highlights notable variations in mortality trends of Alcoholic Cirrhosis group; suggesting the detrimental impact of Alcohol use. Additionally; sharp rising AAMRs till 2035 suggest the utilization of multidisciplinary approach and precise healthcare policies.


Figure: General Trends of Age Associated Mortality Rates for Cirrhosis


Figure: Regional Trends of Age Associated Mortality Rates for Cirrhosis

Disclosures:
Arbaz Hassan indicated no relevant financial relationships.
Usman Afzal indicated no relevant financial relationships.
Muhammad Saim indicated no relevant financial relationships.
Ahmad Sarim Aziz indicated no relevant financial relationships.
Anfal Hamza indicated no relevant financial relationships.
Talha Sajjad indicated no relevant financial relationships.
Faiza Naz indicated no relevant financial relationships.
Tehreem Rao indicated no relevant financial relationships.
Areeba Aamir Ali Basaria indicated no relevant financial relationships.
Atif Nawaz Malik indicated no relevant financial relationships.
Farah Shehryar indicated no relevant financial relationships.

Arbaz Hassan, MBBS¹, Usman Afzal, MD², Muhammad Saim, MBBS³, Ahmad Sarim Aziz, MBBS⁴, Anfal Hamza, MBBS¹, Talha Sajjad, MBBS, MD¹, Faiza Naz, MBBS⁵, Tehreem Rao, MBBS⁶, Areeba Aamir Ali Basaria, ⁶, Atif Nawaz Malik, MBBS¹, Farah Shehryar, MBBS⁷. P5863 - Comparative Analysis and Forecasting of Nationwide Mortality Trends in Liver Cirrhosis vs Alcoholic Cirrhosis of Liver in the US Population Using CDC Wonder Database (1999-2023) and ARIMA Model, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.