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. 2010 Aug;105(8):1782-7.
doi: 10.1038/ajg.2010.46. Epub 2010 Feb 23.

Alcoholic liver disease-related mortality in the United States: 1980-2003

Helga Paula  1 , Sumeet K Asrani, Nicholas C Boetticher, Rachel Pedersen, Vijay H Shah, W Ray Kim
Affiliations

Alcoholic liver disease-related mortality in the United States: 1980-2003

Helga Paula et al. Am J Gastroenterol. 2010 Aug.

Abstract

Objectives: Data on temporal changes in alcoholic liver disease (ALD)-related mortality in the United States are lacking. This longitudinal assessment is important, given the divergent data on trends in worldwide ALD-related mortality, concerns for underestimation of mortality attributed to ALD in previous investigations, and shifting attention to hepatitis C virus (HCV)-related mortality.

Methods: We analyzed mortality data compiled in the multiple cause-of-death public-use data file from the National Vital Statistics System from 1980 to 2003 using categorization by both International Classification of Diseases (ICD)-9 and ICD-10 systems. The main outcome measure was age- and sex-adjusted death rates attributable to ALD, HCV, or both (ALD/HCV) listed as immediate or underlying cause of death.

Results: A total of 287,365 deaths were observed over the 24-year period. Age- and sex- adjusted incidence rates of ALD-related deaths decreased from 6.9/100,000 persons in 1980 to 4.4/100,000 persons by 2003. After introduction of HCV diagnostic testing, HCV-related liver mortality increased to 2.9/100,000 persons by 2003. Death rates for subjects with concomitant ALD/HCV rose to 0.2/100,000 persons by 1999 and then remained unchanged through 2003. Age-specific mortality related to ALD was highest in the ages of 45-64 years. Between 1980 and 2003, the age- and sex-adjusted ALD-related mortality (per 100,000 persons) decreased from 6.3 to 4.5 among Caucasians, 11.6 to 4.1 among African Americans, and 8.0 to 3.7 among the "other" race group.

Conclusions: Despite a decline in ALD-related mortality, the proportion of alcohol-related liver deaths is still considerably large and comparable in scope to that of HCV.

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Conflict of interest statement

CONFLICT OF INTEREST

Guarantor of the article: Vijay Shah, MD.

Specific author contributions: Study concept and design: Helga Paula, Sumeet K. Asrani, Nicholas C. Boetticher, Vijay H. Shah, and W. Ray Kim; acquisition of data: Helga Paula, Sumeet K. Asrani, Nicholas C. Boetticher, and Rachel Pedersen; analysis and interpretation of data: Helga Paula, Sumeet K. Asrani, Nicholas C. Boetticher, Rachel Pedersen, Vijay H. Shah, and W. Ray Kim; drafting of the manuscript: Helga Paula and Sumeet K. Asrani; critical revision of the manuscript for important intellectual content: Sumeet K. Asrani, Rachel Pedersen, Vijay H. Shah, and W. Ray Kim; statistical analysis: Rachel Pedersen; obtained funding: Sumeet K Asrani, Vijay H. Shah, and W. Ray Kim; administrative, technical, or material support: none; study supervision: Vijay H. Shah and W. Ray Kim; and approval of final submitted draft: Helga Paula, Sumeet K. Asrani, Nicholas C. Boetticher, Rachel Pedersen, Vijay H. Shah, and W. Ray Kim.

Potential competing interests: None.

Figures

Figure 1
Figure 1
Age at death due to alcoholic liver disease (ALD), hepatitis C virus infection (HCV)-related liver disease, or both ALD and HCV (ALD/HCV).
Figure 2
Figure 2
Age- and sex-adjusted mortality for patients with alcoholic liver disease (ALD), hepatitis C (HCV), and both ALD/HCV. Age- and sex-adjusted ALD mortality (per 100,000 persons) decreased from 6.9 (1980) to 4.4 (2003). HCV-related age- and sex-adjusted mortality (per 100,000 persons) rose from 2.1 (1998) to 2.9 (2003). Death rates in the combined ALD/HCV group remained fairly constant from 1999 to 2003 (0.2/100,000).
Figure 3
Figure 3
Age-specific mortality for patients with alcoholic liver disease (ALD).
Figure 4
Figure 4
Age- and sex-adjusted mortality for patients with alcoholic liver disease (ALD) by race. The age- and sex-adjusted ALD-related mortality (per 100,000 persons) decreased from 6.3 (1980) to 4.5 (2003) among Caucasians, 11.6 (1980) to 4.1 (2003) among African Americans, and 8.0 (1980) to 3.7 (2003) among the “other” non-Caucasian, non-African-American race group.
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