SAT-605 - Trends and Disparities in Fatty Liver Related Mortality in Diabetes Mellitus Patients in the United States (1999-2020): A CDC WONDER Database Analysis

Introduction
Fatty liver disease, particularly non-alcoholic fatty liver disease (NAFLD), is strongly associated with metabolic disorders such as diabetes mellitus and has become a global public health concern. Abnormal accumulation of lipid in hepatocytes alters hepatic insulin sensitivity, prompts chronic inflammation, and disrupts glucose homeostasis. Conversely, diabetes accelerates the progression of NAFLD to non-alcoholic steatohepatitis, fibrosis, and cirrhosis of the liver.
Methodology
We analyzed CDC WONDER data (1999–2020) for persons over age 25 who had fatty liver (K76.0) and diabetes mellitus (E10–14). Age-adjusted mortality rates (AAMRs) per 100,000 were classified by regional and demographic distribution. Annual percent changes (APCs) stratified by year, sex, race/ethnicity, urbanization, and geographic location with 95% confidence intervals were calculated using joinpoint regression analysis.
Results
In trend analysis, proportionate mortality is depicted. Females showed the greater overall increase across 1999–2020 (AAPC = 12.94% [12.0589–13.8290]) compared with males (AAPC = 11.60% [10.3858–12.8253]), although males demonstrated clear late acceleration, with the trend rising from 1999–2015 (APC = 9.76% [8.4645–11.0701]) to a steeper 2015–2020 (APC = 17.69% [14.0320–21.4744]). For race/ethnicity, White individuals had a slightly higher overall 1999–2020 increase (AAPC = 12.80% [11.9975–13.6068]) than the non-Hispanic or Latino group (AAPC = 12.46% [10.9436–13.9947]), but the non-Hispanic or Latino cohort showed the strongest late-period acceleration, increasing sharply in 2018–2020 (APC = 23.76% [8.8359–40.7331]) after 1999–2018 (APC = 11.33% [10.3551–12.3151]). Regionally, the South (Census Region 3) had a higher sustained increase (AAPC = 14.21% [13.1897-15.2310]) than the West (Census Region 4) (AAPC = 9.24% [8.2459-10.2495]). By urbanization, large central metro areas demonstrated acceleration after 2013, with 1999–2013 (APC = 7.19% [5.4022–9.0061]) increasing to 2013–2020 (APC = 13.31% [10.4693–16.2294]), and an overall 1999–2020 AAPC of 9.19% (7.7768–10.6269). At the state level, California showed a smaller but significant overall rise (AAPC = 4.97%*[3.7311-6.2295]), which was lower than the national subgroup trends reported above.
Conclusion
In the last two decades, the death rate from diabetes mellitus-associated fatty liver has increased significantly, with widening disparities by age, sex, race, and geography. Early detection of elevated blood glucose levels and deranged LFTs and focused prevention efforts are urgently needed to curb these preventable deaths. These findings highlight the urgent need to restore preventive care, mitigate hepatotoxicity in diabetes management, and address disparities to reverse the current escalating burden of diabetes-associated fatty liver mortality.

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