P1661 - Mortality Trends of Hepatorenal Syndrome in Older Adults in the United States: A Retrospective Analysis From 1999 to 2023

Faryal Altaf, MD¹, Obaid Ur Rehman, MBBS², Eeshal Fatima, MBBS², Furqan Hassan, MBBS³, Uswa Hasana, MBBS⁴, Syed Nubaid Hussain, MBBS⁵, Raj Kumar, MD⁶, Amna Parvez, MBBS⁷, Zain Ali Nadeem, ⁸, Aimen Nadeem, MBBS⁹, Omer Usman, MD¹⁰, Deipthan Prabakar, MD¹¹, Harish Patel, MD¹
1BronxCare Health System, Bronx, NY; 2Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; 3Nishtar Medical University, Multan, Punjab, Pakistan; 4Fatima Jinnah Medical University, Lahore, Punjab, Pakistan; 5Dow International Medical College, Karachi, Sindh, Pakistan; 6I.Horbachevsky Ternopil National Medical University, Ternopil, Ternopil's'ka Oblast', Ukraine; 7Dow Medical College, Karachi, Sindh, Pakistan; 8Allama Iqbal Medical College, Lahore, Punjab, Pakistan; 9King Edward Medical University, Lahore, Punjab, Pakistan; 10Texas Tech University Health Sciences Center, El Paso, TX; 11Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX

Introduction: Hepatorenal syndrome (HRS) is a fatal complication of liver cirrhosis with high mortality, particularly in advanced stages. While clinical factors influencing mortality are studied, demographic impacts remain poorly understood. This study analyzes HRS mortality trends by age, sex, race/ethnicity, and region in the U.S.

Methods: CDC-WONDER data from 1999–2023 was used for individuals aged 45+ with HRS (ICD-10 K76.7) as the primary cause of death. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 1 million were calculated. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC).

Results: From 1999–2020, there were 85,348 deaths (AAMR: 32.35). AAMR dropped from 39.28 (1999) to 30.18 (2007), stabilized until 2018 (29.98), and rose to 34.69 in 2020 (APC: 5.99), showing an overall decline (AAPC: -0.79).

Sex Disparities: Males had 64.3% of deaths, with AAMR of 44.45 vs. 21.43 in females. Male AAMR fell from 56.29 (1999) to 45.61 (2020), while female AAMR declined (24.94 to 19.22) until 2007, then rose to 25.03 in 2020, especially post-2018 (APC: 6.91).

Racial/Ethnic Disparities: NH Whites had most deaths (72.49%), followed by Hispanics (13.08%) and NH Blacks (9.92%). Highest AAMRs: NH American Indians (94.82), Hispanics (46.98), NH Whites (30.98), NH Blacks (30.61), NH Asians (17.81).

Age Trends: Highest death share: ages 55–64 (31.84%), 45–54 (25.73%), 65–74 (23.72%). Highest CMRs: ages 75–84 (41.08), 65–74 (39.66), 55–64 (35.35).

2021–2023 Trends: 15,662 deaths (AAMR: 35.52). AAMR peaked at 37.37 in 2021, then declined (2023: 33.94). Males: 9,573 deaths (AAMR: 45.73); females: 6,089 deaths (AAMR: 26.31). NH AI had highest AAMR (145.20), followed by Hispanics (42.30), NH Whites (37.31), NH Blacks (24.18), NH Asians (13.90). Highest state AAMR: Alaska (pre-2020, 58.04); North Dakota (2021–2023, 83.68).

Discussion: HRS mortality shows stark disparities by sex, age, ethnicity, and region. While males and NH American Indians remain most affected, mortality has increased among females, NH Whites, and middle-aged adults, highlighting the need for focused public health strategies.


Figure: Mortality Trends of Hepatorenal Syndrome (a) for Overall and Sex Stratified Population; (b) According to 10 Year Age Groups; (c) According to Race/Ethnicity; (d) Across Census Regions in Older Adults in the United States from 1999 to 2020


Figure: Table of AAMR and Deaths/APC and AAPC's from 1999-2020 and Mortality Trends of Hepatorenal Syndrome according to (a) Urbanization from 1999-2020; (b) States

Disclosures:
Faryal Altaf indicated no relevant financial relationships.
Obaid Ur Rehman indicated no relevant financial relationships.
Eeshal Fatima indicated no relevant financial relationships.
Furqan Hassan indicated no relevant financial relationships.
Uswa Hasana indicated no relevant financial relationships.
Syed Nubaid Hussain indicated no relevant financial relationships.
Raj Kumar indicated no relevant financial relationships.
Amna Parvez indicated no relevant financial relationships.
Zain Ali Nadeem indicated no relevant financial relationships.
Aimen Nadeem indicated no relevant financial relationships.
Omer Usman indicated no relevant financial relationships.
Deipthan Prabakar indicated no relevant financial relationships.
Harish Patel indicated no relevant financial relationships.

Faryal Altaf, MD¹, Obaid Ur Rehman, MBBS², Eeshal Fatima, MBBS², Furqan Hassan, MBBS³, Uswa Hasana, MBBS⁴, Syed Nubaid Hussain, MBBS⁵, Raj Kumar, MD⁶, Amna Parvez, MBBS⁷, Zain Ali Nadeem, ⁸, Aimen Nadeem, MBBS⁹, Omer Usman, MD¹⁰, Deipthan Prabakar, MD¹¹, Harish Patel, MD¹. P1661 - Mortality Trends of Hepatorenal Syndrome in Older Adults in the United States: A Retrospective Analysis From 1999 to 2023, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.