Rising liver disease mortality in the United States, 1999-2023: Temporal trends and disparities

Liver disease (LD) remains a growing public health concern in the United States (US) despite declining mortality from other major chronic conditions, including cardiovascular disease and many cancers.

We conducted a nationwide ecological time-trend study of adults aged 25 years and older using the Centers for Disease Control Wide Ranging Online Data for Epidemiologic (CDC WONDER) Underlying Cause of Death database (1999-2023). We assessed mortality counts and age-adjusted mortality rates (AAMRs) overall and by subtype, sex, age, race/ethnicity, census region, state, and 2013 NCHS urbanization. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC) with 95 % confidence intervals (CIs).

During 1999-2023, 1.86 million liver-related deaths occurred, with annual deaths nearly doubling. The overall AAMR rose from 28.49 to 36.71 per 100,000 (AAPC: +1.01 %). Liver cancer (LC) (28.6 %) and alcoholic liver disease (ALD) (24.9 %) accounted for over half; ALD increased most rapidly (AAPC: +2.31 %), while viral hepatitis mortality declined (AAPC: -4.53 %). Female mortality rose faster than male (AAPC: +1.49 % vs +0.68 %). Adults 55-74 had the most deaths, but 25-34 showed the largest relative increase (AAPC: +3.83 %). In 2023, Hispanics had the highest AAMR (44.22 per 100,000); the West and South were the leading regions. Nonmetropolitan areas exhibited higher and more rapidly rising AAMRs. A post-2019 acceleration coincided with COVID-19.

U.S. death toll from LD has risen substantially, driven largely by ALD and LC, with clear demographic and geographic disparities. Urgent priorities include expanded screening, viral hepatitis elimination, and improved access to liver care, particularly in high-burden states and rural areas. Strategies to reduce harmful alcohol use and to maintain continuity of chronic liver disease management during system stress are also essential.