P0933 - Geographical Variations in Mortality Rates From Chronic Liver Disease and Cirrhosis in the US in Younger Adults: A Time-Trend Analysis Using the CDC’s National Center of Health Statistics Database, 2000-2020

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Yazan Abboud, MD

Rutgers New Jersey Medical School
Newark, NJ

Yazan Abboud, MD¹, Anna G. Mathew, BA¹, John Esli Medina Morales, MD¹, Fouad Jaber, MD², Saqr Alsakarneh, MD², Yi Jiang, MD³, Nikolaos T.. Pyrsopoulos, MD, PhD, MBA¹
¹Rutgers New Jersey Medical School, Newark, NJ; ²University of Missouri-Kansas City, Kansas City, MO; ³Cedars-Sinai Medical Center, Los Angeles, CA

Introduction: Previous data showed increasing mortality from chronic liver disease and cirrhosis (CLDC) in younger adults in the US. However, there are limited data on geographical variations of sex-specific CLDC-related mortality trends. The aim of this study was to conduct a time-trend analysis of CLDC mortality rates in younger adults using a nationwide US database, the CDC’s NCHS database.

Methods: Data were collected from the NCHS database, which is the most comprehensive source of mortality statistics in the US, covering 100% of the US population. CLDC mortality rates in younger adults (aged < 55 years) were age-adjusted to the standard 2000 US population using SEER*Stat software and were categorized by sex and US state. Time-trends, reported as annual percentage change (APC) and average APC (AAPC), were calculated using Joinpoint Regression Software utilizing Monte Carlo permutation analysis to estimate the best-fit trend. Sex-specific pairwise comparison was conducted using the tests of parallelism and coincidence, and the absolute AAPC difference was evaluated using parametric estimations (2-sided P-value cut-off at 0.05).

Results: CLDC mortality rates in younger men (165,619 deaths) varied based on state and were either increasing, stable, or decreasing. On the other hand, in younger women (80,530 deaths), CDLC mortality rates were increasing in most states and stable in a few. A greater increase in CLDC mortality rates in younger women compared to counterpart men with non-parallel data was seen in Alabama, Arizona, Arkansas, Colorado, Florida, Louisiana, Maryland, Massachusetts, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, Virginia, Washington, and West Virginia (P-values< 0.05) (Table 1). The biggest AAPC-difference in sex-specific trends was seen in West Virginia (AAPC-difference=4.08, P< 0.001) and Pennsylvania (AAPC-difference=3.84, P< 0.001).

Discussion: Our nationwide analysis of nearly 100% of deaths attributed to CLDC in younger adults showed that West Virginia and Pennsylvania, which are part of UNOS Region 2, were the states with the biggest disparities in CLDC outcomes between younger women and men. Previous data showed that UNOS Region 2 had shortage in living donors, longer waitlist for liver transplantation, and accounted for significant number of annual deaths on liver transplant waitlist. Future studies are warranted to further investigate the disparities in younger adults with the goal to improve outcomes in all US states.

US State	Deaths (N=716,651)^a	Trends^b			Sex-specific AAPC difference^c (95% CI)	Pairwise comparison P-values
		Time period	APC (95% CI)	AAPC (95% CI)		Sex-specific AAPC difference	Coincidence^d	Parallelism^e
Alabama
Women	1,368 (0.19%)	2000-2010	0.04 (-3.46 to 3.67)	3.80 (1.62 to 6.03)	-2.73 (-5.11 to -0.36)	0.02	< 0.001	< 0.001
		2010-2020	7.70 (4.61 to 10.88)
Men	2,619 (0.36%)	2000-2013	-0.67 (-1.54 to 0.21)	1.07 (0.19 to 1.96)
		2013-2020	4.38 (2.15 to 6.65)
Arizona
Women	2,685 (0.37%)	2000-2020	3.21 (2.41 to 4.02)	3.21 (2.41 to 4.02)	-3.51 (-4.74 to -2.27)	< 0.001	< 0.001	< 0.001
Men	4,700 (0.65%)	2000-2008	-3.50 (-5.49 to -1.46)	-0.30 (-1.26 to 0.68)
		2008-2020	1.90 (0.80 to 3.01)
Arkansas
Women	739 (0.10%)	2000-2020	4.26 (2.56 to 5.99)	4.26 (2.60 to 6.00)	-2.22 (-4.12 to -0.33)	0.02	< 0.001	0.008
Men	1,436 (0.20%)	2000-2020	2.04 (0.97 to 3.12)	2.03 (0.97 to 3.12)
Colorado
Women	2,071 (0.28%)	2000-2020	4.62 (3.69 to 5.55)	4.61 (3.70 to 5.54)	-2.06 (-3.22 to -0.88)	0.001	< 0.001	0.03
Men	3,635 (0.51%)	2000-2020	2.56 (1.74 to 3.40)	2.56 (1.73 to 3.40)
Florida
Women	5,831 (0.81%)	2000-2020	1.26 (0.71 to 1.82)	1.26 (0.70 to 1.81)	-2.45 (-3.48 to -1.42)	< 0.001	< 0.001	< 0.001
Men	11,084 (1.54%	2000-2011	-2.74 (-3.89 to -1.59)	-1.19 (-2.07 to -0.29)
		2011-2020	-0.74 (-0.87 to 2.38)
		2017-2020	7.31 (5.48 to 9.18)
Louisiana
Women	1,016 (0.14%)	2000-2020	2.95 (1.55 to 4.37)	2.95 (1.55 to 4.36)	-3.15 (-4.62 to -1.68)	< 0.001	< 0.001	< 0.001
Men	2,148 (0.30%)	2000-2020	-0.19 (-0.89 to 0.50)	-0.195 (-0.88 to 0.50)
Maryland
Women	1,086 (0.15%)	2000-2017	-1.52 (-2.79 to -0.24)	2.09 (-0.45 to 4.68)	-3.40 (-6.47 to -2.16)	0.03	< 0.001	0.008
		2017-2020	25.19 (6.08 to 47.75)
Men	2,140 (0.29%)	2000-2014	-4.56 (-5.87 to -3.23)	-1.31 (-2.99 to 0.40)
		2014-2020	6.72 (1.23 to 12.51)
Massachusetts
Women	1,392 (0.19%)	2000-2015	0.73 (-0.62 to 2.11)	3.86 (2.16 to 5.58)	-3.60 (-5.60 to -1.59)	< 0.001	< 0.001	< 0.001
		2015-2020	13.84 (7.37 to 20.69)
Men	2,853 (0.40%)	2000-2020	0.27 (-0.84 to 1.39)	0.266 (-0.84 to 1.38)
Missouri
Women	1,246 (0.17%)	2000-2015	2.59 (0.90 to 4.32)	4.69 (2.64 to 6.77)	-3.43 (-5.73 to -1.12)	0.004	< 0.001	0.03
		2015-2020	11.24 (3.79 to 19.22)
Men	2,634 (0.36%)	2000-2020	1.26 (0.17 to 2.36)	1.26 (0.17 to 2.38)
Ohio
Women	2,835 (0.39%)	2000-2008	0.87 (-2.01 to 3.82)	3.40 (2.07 to 4.76)	-2.59 (-4.02 to -1.16)	< 0.001	< 0.001	< 0.001
		2008-2020	5.14 (3.74 to 6.55)
Men	5,834 (0.81%)	2000-2020	0.82 (0.30 to 1.34)	0.82 (0.30 to 1.34)
Oklahoma
Women	1,452(0.20%)	2000-2020	3.92 (2.91 to 4.94)	3.92 (2.91 to 4.94)	-3.72 (-0.96 to -3.31)	0.001	< 0.001	0.003
Men	2,695 (0.37%	2000-2020	1.59 (0.51 to 2.67)	1.59 (0.51 to 2.67)
Pennsylvania
Women	2,385 (0.33%)	2000-2020	2.82 (2.05 to 3.60)	2.81 (2.04 to 3.59)	-3.84 (-4.86 to -2.82)	< 0.001	< 0.001	< 0.001
Men	5,099 (0.71%)	2000-2020	-1.02 (-1.78 to -0.26)	-1.02 (-1.77 to -0.25)
South Carolina
Women	1,379 (0.19%)	2000-2020	3.01 (1.84 to 4.19)	3.00 (1.84 to 4.19)	-2.87 (-4.18 to -1.55)	< 0.001	< 0.001	< 0.001
Men	2,763 (0.38%)	2000-2020	0.14 (-0.63 to 0.92)	0.14 (-0.62 to 0.91)
Virginia
Women	1,608 (0.22%)	2000-2020	3.44 (2.46 to 4.43)	3.44 (2.46 to 4.42)	-3.38 (-4.58 to -2.18)	< 0.001	< 0.001	< 0.001
Men	3,391 (0.47%)	2000-2020	0.06 (-0.76 to 0.88)	0.05 (-0.76 to 0.88)
Washington
Women	2,231 (0.31%)	2000-2020	3.88 (2.88 to 4.88)	3.877 (2.88 to 4.88)	-1.45 (-2.67 to -0.23)	0.02	< 0.001	0.01
Men	3,784 (0.52%)	2000-2020	2.42 (1.60 to 3.26)	2.42 (1.60 to 3.26)
West Virginia
Women	485 (0.06%)	2000-2020	4.96 (3.32 to 6.63)	4.96 (3.32 to 6.62)	-4.08 (-5.94 to -2.22)	< 0.001	< 0.001	0.001
Men	1,313 (0.18%)	2000-2020	0.88 (-0.21 to 2.00)	0.88 (-0.21 to 1.99)

Table: Table 1: Sex-Specific Trends for Chronic Liver Disease and Cirrhosis (CLDC) Mortality in Younger Adults Categorized by US State.
a Data are presented as death count numbers followed by percentages of the death count numbers from the total cases of deaths attributed to CLDC in the database.
b Time-trends were computed using Joinpoint Regression Program (v4.9.0.1, NCI) with 3 maximum joinpoints allowed (4-line segments).
c A negative value indicates a greater AAPC in women compared to men.
d Tests whether sex-specific trends were identical. A significant P-value indicates that the trends were not identical (i.e., they had different mortality rates and coincidence was rejected).
e Tests whether sex-specific trends were parallel. A significant P-value indicates that the trends were not parallel (i.e., parallelism was rejected).
* Indicates that there were too few CLDC-related deaths per one calendar year at least hindering the calculation of a rate and thus a trend.

Disclosures:

Yazan Abboud indicated no relevant financial relationships.

Anna Mathew indicated no relevant financial relationships.

John Esli Medina Morales indicated no relevant financial relationships.

Fouad Jaber indicated no relevant financial relationships.

Saqr Alsakarneh indicated no relevant financial relationships.

Yi Jiang indicated no relevant financial relationships.

Nikolaos Pyrsopoulos: CytoSorbents – Grant/Research Support. Durect – Grant/Research Support. Gilead – Grant/Research Support. Grifols – Grant/Research Support. Mallinckrodt Pharmaceuticals – Consultant. Ocelot Bio – Grant/Research Support. Salix – Grant/Research Support.

Yazan Abboud, MD¹, Anna G. Mathew, BA¹, John Esli Medina Morales, MD¹, Fouad Jaber, MD², Saqr Alsakarneh, MD², Yi Jiang, MD³, Nikolaos T.. Pyrsopoulos, MD, PhD, MBA¹. P0933 - Geographical Variations in Mortality Rates From Chronic Liver Disease and Cirrhosis in the US in Younger Adults: A Time-Trend Analysis Using the CDC’s National Center of Health Statistics Database, 2000-2020, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.