P5796 - National Mortality Trends in Decompensated Cirrhosis (1999–2023) and Forecast to 2030: A CDC WONDER-Based ARIMA Analysis

Allah Dad, MD¹, Fahad Saleem, MBBS², Muhammad Waqas Afzal, MBBS, MD³, Ashar Abdullah, MD⁴, Erum Siddiqui, MBBS⁵, Fnu Veena, MD⁶, Muhammad Arham, ⁷, Usman Mazhar, MBBS⁸, Kinza Bakht, MBBS⁹, Arbaz Hassan, MBBS¹⁰, Adnan Bhat, MD¹¹
1Shiekh Zayed Medical College Rahim Yar Khan, Pakistan, Kot Addu, Punjab, Pakistan; 2Punjab Medical College, Faisalabad, Pakistan, Faisalabad, Punjab, Pakistan; 3Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan, Multan, Punjab, Pakistan; 4Quaid-e-Azam Medical College, Bahawalpur, Pakistan, Bahawalpur, Punjab, Pakistan; 5Jinnah Sindh Medical University, Karachi, Pakistan, Karachi, Sindh, Pakistan; 6BronxCare Health System, Bronx, NY; 7Sheikh Zayed Medical College, Pakistan, Rahim Yar Khan, Punjab, Pakistan; 8Rawalpindi Medical University, Pakistan, Rawalpindi, Punjab, Pakistan; 9Sheikh Zayed Medical College Rahim Yar Khan, Muzaffargarh, Punjab, Pakistan; 10Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan, Rahim Yar Khan, Punjab, Pakistan; 11University of Florida, Gainesville, FL

Introduction: Decompensated cirrhosis (DC) causes 55,000 liver-related deaths annually in the U.S., with a mortality rate of 85%. We hypothesized that significant disparities in mortality trends exist across sociodemographic groups. This study analyzed national DC-related mortality trends from 1999 to 2023 and projected rates through 2030.

Methods: We analyzed CDC WONDER data on DC-related deaths using ICD-10 codes K70.31, R17, I85.01, I86.4, K72.90–K72.91, R18.8, and K74.60–K74.69. Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, age, race/ethnicity, and census region. Temporal trends were evaluated using Joinpoint regression to estimate annual percentage changes (APCs). ARIMA models with Box-Cox transformation were fitted after ADF/KPSS tests, with validation by residual checks.

Results: Between 1999-2023, DC accounted for 1,801,091 deaths in the United States, with mortality trends demonstrating four distinct phases: an initial decline (1999-2009; APC -1.36%, p< 0.001), followed by gradual increases (2009-2018; APC +1.24%, p< 0.001), a dramatic pandemic-era surge (2018-2021; APC +7.43%, p< 0.001), and a recent modest decline (2021-2023; APC -3.54%, p=0.022). Significant disparities emerged across demographic groups, with males and younger adults (25-44 years) experiencing the most pronounced increases during 2018-2021 (APC +20.84%, p=0.000007). Geographic variations were evident, with the West and South experiencing the most significant pandemic surges. Racial/ethnic disparities were particularly striking, as American Indian/Alaska Native populations reached peak mortality in 2021 (AAMR 157.14) before showing a significant decline (APC -12.70%, p< 0.001), while White and Hispanic populations sustained substantial increases. Asian/Pacific Islander groups maintained the lowest mortality rates throughout the study period. Projections indicate a gradual 6% decline in age-adjusted mortality rates by 2030, decreasing from 31.44 (95% CI 30.68-32.25) in 2024 to 29.57 (95% CI 28.09-31.20) in 2030.

Discussion: Decompensated cirrhosis mortality showed dynamic trends, with a concerning pandemic surge and persistent disparities among males, young adults, and American Indian/Alaska Native populations. While recent declines and projected trends are encouraging, targeted interventions for high-risk groups remain critical to address ongoing inequities in liver disease outcomes.


Figure: Graphical illustration 1: Figure 1: Average AAMR by states (top 5 states). Figure 2: Average AAMR by states (bottom 5 states). Figure 3: AAMR by census region (1999-2020). Figure 4: AAMR by census region (2021-2023)


Figure: Graphical illustration 2: Figure 1: Overall and gender-stratified mortality trends from 1999 to 2023. Figure 2: AAMR stratification by 2013 Census regions (1999-2020). Figure 3: AAMR stratification by 2013 census regions (2021-2023). Figure 4: AAMR stratified by states (1999-2020). Figure 5: AAMR stratified by states (2021-2023)

Disclosures:
Allah Dad indicated no relevant financial relationships.
Fahad Saleem indicated no relevant financial relationships.
Muhammad Waqas Afzal indicated no relevant financial relationships.
Ashar Abdullah indicated no relevant financial relationships.
Erum Siddiqui indicated no relevant financial relationships.
Fnu Veena indicated no relevant financial relationships.
Muhammad Arham indicated no relevant financial relationships.
Usman Mazhar indicated no relevant financial relationships.
Kinza Bakht indicated no relevant financial relationships.
Arbaz Hassan indicated no relevant financial relationships.
Adnan Bhat indicated no relevant financial relationships.

Allah Dad, MD¹, Fahad Saleem, MBBS², Muhammad Waqas Afzal, MBBS, MD³, Ashar Abdullah, MD⁴, Erum Siddiqui, MBBS⁵, Fnu Veena, MD⁶, Muhammad Arham, ⁷, Usman Mazhar, MBBS⁸, Kinza Bakht, MBBS⁹, Arbaz Hassan, MBBS¹⁰, Adnan Bhat, MD¹¹. P5796 - National Mortality Trends in Decompensated Cirrhosis (1999–2023) and Forecast to 2030: A CDC WONDER-Based ARIMA Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.