Demographic and regional trends of mortality associated with hepatic cirrhosis and chronic kidney disease, in the United States, 1999-2020: A CDC WONDER database analysis.

BACKGROUND: Hepatic cirrhosis and chronic kidney disease (CKD) often co-exist, exacerbating each other through shared inflammatory and hemodynamic pathways. Portal hypertension in cirrhosis impairs renal blood flow, increasing CKD risk. This study aims to highlight the annual trends and demographic differences in mortality due to hepatic cirrhosis and CKD in the US population from 1999-2020 METHODS: Cirrhosis associated CKD-related mortality trends were analyzed from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) multiple-cause of death database. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Trends and annual percent changes (APCs) were assessed overall and stratified by sex, race/ethnicity, urbanization status, and census region. RESULTS: Between 1999 and 2020, 45,471 cirrhosis-associated CKD-related deaths occurred among adults in the U.S. The AAMR increased from 0.27 in 1999 to 1.14 in 2020 (APC, 6.84* [6.05 to 7.98], p < 0.000001) in the overall population. Over the study period, males averaged a considerably higher AAMR than females (overall AAMR: 0.83 vs 0.42, p < 0.001. Non-Hispanic (NH) American Indian or Alaskan Native had the highest AAMR (1.73), followed by Hispanics or Latinos (AAMR;1.2), NH Black or African Americans (AAMR; 0.89), NH Asian or Pacific Islander (AAMR; 0.48) and NH White (AAMR; 0.48) [p < 0.001]. West region had the highest AAMR (0.7), followed by South (AAMR; 0.6), Midwest (AAMR; 0.5), and Northeast (AAMR; 0.4). Moreover, metropolitan areas had a higher AAMR than non-metropolitan areas (AAMR: 0.6 vs 0.5, p < 0.001). CONCLUSION: Cirrhosis-associated CKD mortality increased significantly from 1999 to 2020. The highest AAMRs were observed among men, the NH American Indian or Alaskan Native population, and individuals residing in the West region and metropolitan areas. Targeted interventions addressing both hepatic cirrhosis and CKD are essential, with a particular emphasis on high-burden population.