In 1998, chronic liver disease (CLD) was the tenth leading cause of death in the United States.
Important etiologies included alcohol and hepatitis C.
It is thought that the methods used for calculating CLD mortality rates using death certificates may underestimate hepatitis C-related CLD mortality.
In this study, investigators from Atlanta, Georgia, assessed patterns of CLD deaths from 1990 to 1998. The team used an expanded definition that included death certificates where CLD, viral hepatitis, or CLD-related sequelae were reported as the underlying cause.
They calculated overall age-specific and age-adjusted mortality rates.
The investigators found that CLD mortality had declined by 5% overall from 1990 to 1994. However, it remained unchanged from 1995 to 1998.
They established that corresponding decreases occurred for all causes of CLD, except hepatitis C. Rates of hepatitis C increased 220% from 1993 to 1998.
Rates of CLD mortality declined in all ethnic groups, except American Indians and Alaska Natives. In these groups rates remained unchanged.
|Rates of hepatitis C increased 220% from 1993 to 1998.|
The team found that, of the 30,933 CLD deaths in 1998, 39% were coded as alcohol related, 15% as hepatitis C, 4% as hepatitis B, and 44% had no recorded cause.
They determined that age-adjusted rates were higher among males than females, and among Hispanics compared with non-Hispanics.
The rates of CLD mortality among American Indians and Alaska Natives were more than twice those of African Americans and whites.
Drs Sirenda Vong and Beth Bell concluded, "1998 CLD deaths and the proportion attributable to viral hepatitis increased by 23% and 19%, respectively, compared with traditional methods."
"Mortality declines of the early 1990s were not sustained after 1994."
"Large disparities in CLD mortality remain, particularly among American Indians and Alaska Natives."