Trends and Demographics of Liver Fibrosis and Cirrhosis-Related Mortality Among Adults Living in the United States From 1999 to 2020: A CDC Wonder Analysis

Abstract

Introduction: Liver cirrhosis, the fifth leading cause of adult mortality, involves progressive, irreversible liver fibrosis and loss of function. Its rising prevalence necessitates studying trends, identifying high-risk groups, and enhancing preventive strategies. This study aims to assess temporal trends and demographic disparities in liver fibrosis and cirrhosis-related mortality in the United States from 1999 to 2020. Methods: Death certificates from the CDC WONDER(Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database for 1999–2020 were analyzed for liver fibrosis and cirrhosis-associated mortality in adults > 25 years. AAMRs per 100 000 were stratified by year, sex, race/ethnicity, and region. Joinpoint Regression (v5.3.0.0) calculated annual percent change (APC) and average APC (AAPC), identifying significant trends (p < 0.05, two-tailed t test). Results: From 1999 to 2020, 787 375 liver cirrhosis-related deaths occurred in adults > 25. AAMR increased from 16.61 (1999) to 18.93 (2020). Men had a higher AAMR (21.51; 95% CI: 21.44 to 21.57) than women (11.73; 95% CI: 11.68 to 11.77). AAMRs were highest in Non-Hispanic (NH) American Indian (26.42; 95% CI: 25.91 to 26.93) followed by Hispanics (24.93; 95% CI: 24.77 to 25.09), NH White (16.71; 95% CI: 16.67 to 16.75), NH Black (15.13; 95% CI: 15.02 to 15.24), and NH Asian/Pacific Islander (9.29; 95% CI: 9.15 to 9.42). By region, the South had the highest AAMR (18.87; 95% CI: 18.8 to 18.93), followed by the West (15.75; 95% CI: 15.67 to 15.82), Midwest (14.55; 95% CI: 14.47 to 14.62), and Northeast (14.17; 95% CI: 14.1 to 14.25). Micropolitan (Nonmetro) areas had the highest AAMR (17.62; 95% CI: 17.49 to 17.74), while Large Fringe Metro Areas had the lowest AAMR (14.2; 95% CI: 14.13 to 14.27). Texas reported the highest AAMR (25.7); Nebraska reported the lowest (9.4). Discussion: Liver cirrhosis-related mortality has risen since 1999, especially among Hispanic adults, men, and those in Southern or nonmetropolitan regions. Targeted prevention is needed to reduce mortality in these high-risk groups.