SAT-653 Silent Epidemics? Trends in Non-Alcoholic Fatty Liver Disease (NAFLD) and Chronic Kidney Disease (CKD) Mortality Among Adults in the United States from 1999 to 2023

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Abstract Disclosure: A. Ahmed: None. H. Ahmad: None. M. Ali: None. F. Ahmed: None. S. abid: None. S. Joshi: None. M. Fatima: None. A. Raza: None. R. Patel: None. S. Eltawansy: None. Background: NAFLD, strongly linked to metabolic syndrome, is now the leading cause of chronic liver disease, particularly in the United States. Similarly, CKD, often driven by diabetes, hypertension, and obesity, poses an escalating public health challenge. Both conditions remain underdiagnosed, leading to delayed treatment and worsened outcomes. This study investigates mortality trends associated with NAFLD and CKD in U.S. adults from 1999 to 2023, examining demographic disparities and regional variations. Methods: Mortality data from the CDC WONDER database (1999-2023) were analyzed using Joinpoint regression to assess NAFLD and CKD-related deaths among U.S. adults aged 25 and older. Age-adjusted mortality rates (AAMRs) per million were calculated, along with the average annual percent change (AAPC) and corresponding 95% confidence intervals (CI). Results: NAFLD among individuals with CKD accounted for 60,149 deaths over 25 years. Between 1999 and 2023, the overall AAMR surged from 4.73 to 16.66 per million, with a staggering AAPC of 5.41 (95% CI: 4.71-6.34, p < 0.000001). Males consistently exhibited higher mortality rates than females (AAMR: 13.23 vs. 7.40); however, the trajectory of increase was steeper in females (AAPC: 6.06, 95% CI: 5.38-6.98) compared to males (AAPC: 4.92, 95% CI: 4.29-5.70,), both with p < 0.000001. Among racial groups, White individuals experienced the sharpest rise (AAMR: 3.43-15.30, AAPC: 6.45, 95% CI: 5.77-7.34, p < 0.000001), followed by Hispanic or Latino populations (AAMR: 10.48-22.36, AAPC: 2.99, 95% CI: 2.14-4.11, p < 0.000001). The Midwest saw the most pronounced increase (AAPC: 6.03, 95% CI: 5.15-7.31, p < 0.000001), followed by the South (AAPC: 5.73, 95% CI: 5.10-6.59, p < 0.000001), where the states with the highest AAMRs were West Virginia (25.34), Texas (21.79), and the District of Columbia (20.07). Urban areas exhibited slightly higher AAMRs than rural areas (9.17 vs. 8.84), yet the mortality trajectory was steeper in rural populations (AAPC: 7.01, 95% CI: 5.87-8.74, p < 0.000001) compared to urban areas (AAPC: 5.14, 95% CI: 4.29-6.28, p < 0.000001). Age-stratified analysis revealed that individuals aged ≥65 years bore the highest mortality burden, with an AAPC of 6.57 (95% CI: 5.92-7.49, p < 0.000001), significantly outpacing the rise observed in those under 65 years (AAPC: 3.58, 95% CI: 2.95-4.33, p < 0.000001). Conclusion: NAFLD and CKD-related mortality has escalated over the past 25 years, with the most notable increases seen in females, Whites, rural areas, and the Midwest and South regions. These disparities emphasize the urgent need for targeted interventions to address the growing mortality burden, especially among vulnerable populations. Presentation: Saturday, July 12, 2025

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