Abstract
BACKGROUND: Chronic liver disease (CLD), traditionally considered a condition of older adults, has shown increasing mortality in younger US adults. Rising rates of alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease (MASLD) have shifted the demographic profile of CLD burden. OBJECTIVE: This study aimed to identify significant trends and disparities in CLD mortality among US adults aged 25-44 years from 2000 to 2020, with analysis stratified by age subgroup, sex, and race/ethnicity. MATERIALS AND METHODS: We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause of Death database. Deaths attributed to CLD were identified using International Classification of Diseases 10th Revision (ICD-10) codes K70 (alcoholic liver disease), K73 (chronic hepatitis), and K74 (fibrosis and cirrhosis). Data were stratified by age (25-34 and 35-44), sex, and race. Crude death rates per 100,000 were calculated. One-way analysis of variance (ANOVA) was performed to evaluate racial disparities within subgroups. RESULTS: CLD mortality increased in all subgroups from 2000 to 2020. The highest rates were observed among men aged 35-44, particularly American Indian or Alaska Native (AI/AN) men, who reached an average of 19.4 deaths per 100,000. Black men and Hispanic women also experienced significant increases. ANOVA confirmed statistically significant racial disparities (p<0.0001) within all sex and age groups. CONCLUSION: CLD mortality is rising among young US adults, with disproportionately high rates in AI/AN and Black populations. These findings underscore the need for earlier screening, expanded public health interventions, and targeted support for underserved communities.