Trends and demographic disparities in heart failure mortality rates in non-alcoholic fatty liver disease: a population-based retrospective study in the United States from 1999 to 2020.

Objectives: This study aimed to analyze two decades heart failure (HF) mortality data in Non-Alcoholic Fatty Liver Disease (NAFLD), now known as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), in the United States (US), identifying patterns and disparities in mortality rates.

Methods: A retrospective analysis was conducted using mortality data from the CDC WONDER database spanning 1999-2020. Age-adjusted mortality rates (AAMRs) per 1,000,000 persons were calculated, and trends were assessed using Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) using Joinpoint 5.0.2. Data were stratified by year, sex, race/ethnicity, urbanization, and census regions.

Results: From 1999-2020, 68,436 HF-related deaths occurred among US adults with NAFLD. The overall AAMR increased from 12.49 in 1999 to 24.30 in 2020, with an AAPC of 3.05 (95% CI: 2.80 to 3.31, P < 0.001), with a steep rise in AAMR from 2017-2020 and an APC of 12.35 (95% CI: 9.71 to 15.99). American Indian or Alaskan natives had the highest AAMRs (28.63), followed by Hispanics (20.05), and African Americans or Blacks (14.51). The highest mortality regionally was in the Southern region (AAMR: 16.05) and nonmetropolitan areas had higher AAMRs than metropolitan areas (16.63 vs. 13.76).

Conclusions: This analysis demonstrated increasing mortality rates from HF in NAFLD, with a sharper increase in recent years. This also showed nonmetropolitan areas, the Southern region of the US, and minority populations had higher mortality rates, which highlights at-risk populations and opportunities for important public health interventions.