Background: Liver disease is an important contributor to high mortality in First Nations Australians. We describe cause-specific mortality by First Nations status in people with cirrhosis. Methods: Population-based retrospective cohort analysis of all adults with cirrhosis admitted to hospitals in the state of Queensland (2007–2022). Patients (1909 First Nations and 20,584 non-First Nations) were followed from the first admission with cirrhosis until date of death, liver transplant, or 31 December 2022, whichever came first. Multivariable Cox regression and Fine and Gray proportional subhazard models were used to assess differences in mortality according to First Nations status. Findings: During a median follow-up of 6.9 years (IQR 3.5–11.1), 995 (52.1%) First Nations and 11,367 (55.2%) non-First Nations patients died. First Nations people died on average 9.4 years younger than non-First Nations Australians (57.0 years (SD = 12.1) vs 66.4 years (SD = 12.2), respectively). Approximately half of First Nations (48.9%) and non-First Nations (50.4%) deaths had liver disease as their underlying cause, and the 10-year liver-related mortality did not differ according to First Nations status (adjusted-sHR = 0.92, 95% CI 0.83–1.01). First Nations patients had a 1.6-fold increased risk of 10-year mortality due to cardiovascular disease (adjusted-sHR = 1.59, 95% CI 1.29–1.96), diabetes (adjusted-sHR = 1.60, 95% CI 1.07–1.52), and infections/parasitic diseases (adjusted-sHR = 1.61, 95% CI 1.12–2.23) vs non-First Nations patients. Interpretation: Mortality due to cardiovascular disease, diabetes, and infections/parasitic diseases are 60% higher in First Nations Australians with cirrhosis. The higher non-liver disease mortality in First Nations Australians reinforces the need for a holistic approach to management of metabolic comorbidities in patients with cirrhosis. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.