Temporal trends and demographic disparities in mortality with co-mention of chronic liver disease and pneumonia in the United States, 1999-2024.

backgroundChronic liver disease is associated with immune dysfunction and increased susceptibility to pneumonia, yet national mortality trends involving both conditions remain poorly characterized. We examined temporal trends and demographic disparities in mortality with co-mention of chronic liver disease and pneumonia in the United States from 1999 to 2024.

methodsUsing data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database, we identified deaths with co-mention of chronic liver disease and pneumonia as multiple causes of death. Age-adjusted mortality rates per 100,000 population were calculated and stratified by sex, age, race and ethnicity, region, and urbanization. Joinpoint regression was used to estimate annual and average annual percent change in mortality rates. Sensitivity analyses excluded deaths with a co-listed U07.1 (COVID-19) code, restricted to the pre-pandemic period, and applied broader diagnostic code definitions.

resultsFrom 1999 to 2024, 81,759 deaths had co-mention of chronic liver disease and pneumonia. The overall mortality rate was stable from 1999 to 2018, rose sharply to a peak in 2021, and declined thereafter but remained above pre-pandemic levels through 2024; this pattern was retained across all sensitivity analyses. Males accounted for most deaths and consistently had higher mortality rates than females, though females showed a significant overall increase in mortality while males did not. Non-Hispanic American Indian/Alaska Native individuals had the highest mortality rate throughout most of the study period, with a sharp increase from 2018 to 2021 followed by a marked decline. The South accounted for the most deaths, while the West had the highest mortality rate by 2024. Non-metropolitan areas showed a greater increase in mortality than metropolitan areas. Most deaths occurred in inpatient medical facilities.

conclusionsMortality with co-mention of chronic liver disease and pneumonia rose sharply during the COVID-19 pandemic and remained persistently elevated through 2024; this pattern was similar in sensitivity analyses excluding deaths with a co-listed U07.1 code and using alternative case definitions. Substantial and sustained disparities were observed, particularly among non-Hispanic American Indian/Alaska Native individuals and non-metropolitan residents. These findings reflect co-occurrence on death certificates rather than a confirmed causal relationship, and highlight priority populations for continued surveillance and targeted public health efforts. CLINICAL TRIAL NUMBER: Not applicable.