P1603 - Geographic and Demographic Patterns of Esophageal Varices Deaths in Cirrhotic U.S. Adults Aged 55 and Older From 1999-2023

Abdul Khuram, DO¹, Ali Zubair, MBBS², Hakim Wazir, MBBS³, Kiran Iqbal, MBBS⁴, Aleena Sharif, MBBS⁵, Maha Sajjad, MBBS⁶, Zoya Aamir, MBBS⁷, Amatul Hadi Hamdana, MBBS⁷, Maaz Ahmed, MBBS⁸, Nayanika Tummala, MD⁹
1University of Connecticut Health, Farmington, CT; 2Sheikh Zayed Medical College Raheem Yar Khan, Lahore, Punjab, Pakistan; 3Gajju Khan Medical College,Swabi Pakistan Medicine department, Shahmansor, Swabi, North-West Frontier, Pakistan; 4Bakhtawar Amin Medical and Dental College Multan, Multan, Punjab, Pakistan; 5Sheikh Zayed Medical College Raheem Yar Khan, Bahawalpur, Punjab, Pakistan; 6King Edward Medical University, Lahore, Lahore, Punjab, Pakistan; 7Dow University of Health Sciences, Karachi, Sindh, Pakistan; 8Sheikh Zayed Medical College Rahim Yar Khan, Lahore, Punjab, Pakistan; 9St. Mary's General Hospital, New York Medical College, Poughkeepsie, NY

Introduction: Esophageal varices, a critical complication of liver cirrhosis driven by portal hypertension, account for 30-50% of life-threatening upper gastrointestinal bleeding events in cirrhotic patients, significantly contributing to mortality. Despite advances in management, persistent disparities in outcomes necessitate a population-level analysis to identify evolving trends and high-risk subgroups.

Methods: This retrospective study analyzed U.S. mortality data (1999-2023) from the CDC WONDER database to investigate deaths related to liver cirrhosis (ICD-10 K74) and esophageal varices (I85) among adults aged ≥55. Age-adjusted mortality rates (AAMR per 1,000,000) were calculated using the 2000 U.S. standard population. Trends were evaluated via segmented log-linear regression (Joinpoint 5.0.2), reporting annual percent change (APC) and average APC (AAPC) with 95% confidence intervals (CIs). Analyses were stratified by demographics, region, state, and urbanization.

Results: A total of 23,085 deaths were recorded (overall AAMR: 11.51). Mortality declined from 15.3 in 1999 to 7.6 in 2006 (APC: -14.50, p=0.08), then surged to 14.4 by 2023 (APC: 3.78, p< 0.01). Males had double the mortality rate of females (AAMR: 15.71 vs. 7.90), with females demonstrating a steeper post-2007 increase (APC: 4.57 vs. 3.24 in males). Racial disparities were pronounced, with Whites exhibiting higher mortality than Blacks (AAMR: 11.79 vs. 9.53). White AAMR declined from 15.3 in 1999 to 7.4 in 2006 (APC: -14.64, p=0.08), then rebounded sharply to 15.7 by 2023 (APC: 4.31, p< 0.001). In contrast, Blacks showed a modest decline (12.3 to 9.4, 1999-2006; APC: -5.78, p=0.04) followed by stable rates (APC: -0.45, p=0.49). Hispanics or Latinos exhibited a higher mortality rate than non-Hispanics (AAMR: 22.27 vs. 10.58). Geographically, the South showed the steepest rise (APC: 4.86, p< 0.001), surpassing the West by 2023 (AAMR: 16.4 vs. 14.3). Texas (25.1) and Colorado (24.3) emerged as high-mortality states.

Discussion: The post-2006 mortality resurgence underscores systemic inequities linked to alcohol-related liver disease, viral hepatitis, and metabolic syndrome, disproportionately impacting males, Hispanics, and Southern and Western regions. Prioritizing early portal hypertension management, equitable care access, and policies targeting alcohol misuse and obesity is critical to reversing this trend.


Figure: Figure 1: Overall AAMR Trend and Gender Disparities


Figure: Figure 2: Racial/Ethnic and Geographical Disparities

Disclosures:
Abdul Khuram indicated no relevant financial relationships.
Ali Zubair indicated no relevant financial relationships.
Hakim Wazir indicated no relevant financial relationships.
Kiran Iqbal indicated no relevant financial relationships.
Aleena Sharif indicated no relevant financial relationships.
Maha Sajjad indicated no relevant financial relationships.
Zoya Aamir indicated no relevant financial relationships.
Amatul Hadi Hamdana indicated no relevant financial relationships.
Maaz Ahmed indicated no relevant financial relationships.
Nayanika Tummala indicated no relevant financial relationships.

Abdul Khuram, DO¹, Ali Zubair, MBBS², Hakim Wazir, MBBS³, Kiran Iqbal, MBBS⁴, Aleena Sharif, MBBS⁵, Maha Sajjad, MBBS⁶, Zoya Aamir, MBBS⁷, Amatul Hadi Hamdana, MBBS⁷, Maaz Ahmed, MBBS⁸, Nayanika Tummala, MD⁹. P1603 - Geographic and Demographic Patterns of Esophageal Varices Deaths in Cirrhotic U.S. Adults Aged 55 and Older From 1999-2023, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.