Unveiling Disparities in Heart Failure and Cirrhosis Related Mortality: CDC WONDER 1999 to 2020

BACKGROUND: Patients with heart failure and cirrhosis are a highly vulnerable population due to increased risk of morbidity and mortality. There is limited evidence on mortality trends by age, sex, race, and geographic location in contemporary years in this vulnerable population. METHODS: Multiple cause of death files from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research from 1999 to 2020 in age ≥ 25 years were used. Death was presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint Trend Analysis Software was used to determine annual percentage change (APC). These were stratified by age, sex, race and ethnicity, location of death (medical facilities, home, hospice, nursing home), regions (Northeast, Midwest, South, and West), states, and rural-urban areas. RESULTS: Total deaths were 98,530 and AAMR was 2.05. The APC from 2001 to 2009 was - 2.80, but from 2009 to 2014 was + 3.16, 2014 to 2018 was + 7.88, and 2018 to 2020 was + 12.23. AAMR were higher in non-Hispanic American Indians (NHAI) (4.11), with a sharp rise in mortality (APC + 14.58, 2013 to 2020). Higher AAMR were observed in the South (2.23) and West (2.24), West Virginia (3.45) and Oklahoma (3.23), rural areas (2.52), males (2.86), and age ≥ 75 years (9.61). Most deaths took place inpatient (48,255). CONCLUSION: There was an initial decline in mortality, however, a rise was observed in recent years. NHAI have the highest AAMR. Higher AAMR are observed in males, in the South and West, and in rural areas. We emphasize the need for targeted interventions addressing these disparities by improving access to resources, surveillance, and management strategies for this vulnerable population.