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Review
. 2018 Jul;131(7):728-734.
doi: 10.1016/j.amjmed.2018.01.047. Epub 2018 Feb 26.

Geographic Variability in Liver Disease-Related Mortality Rates in the United States

Archita P Desai  1 , Prashanthinie Mohan  2 , Anne M Roubal  2 , Ricki Bettencourt  3 , Rohit Loomba  4
Affiliations
Review

Geographic Variability in Liver Disease-Related Mortality Rates in the United States

Archita P Desai et al. Am J Med. 2018 Jul.

Abstract

Purpose: Liver disease is an important cause of morbidity and mortality in the United States. Geographic variations in the burden of chronic liver disease may have significant impact on public health policies but have not been explored at the national level. The objective of this study is to examine interstate variability in liver disease mortality in the United States.

Methods: We compared liver disease mortality from the 2010 National Vital Statistics Report on a state level. States in each quartile of liver disease mortality were compared with regard to viral hepatitis death rates, alcohol consumption, obesity, ethnic and racial composition, and household income. Race, ethnicity, and median household income data were derived from the 2010 US Census. Alcohol consumption and obesity data were obtained from the 2010 Behavioral Risk Factor Surveillance System Survey.

Results and conclusion: We found significant interstate variability in liver disease mortality, ranging from 6.4 to 17.0 per 100,000. The South and the West carry some of the highest rates of liver disease mortality. In addition to viral hepatitis death rates, there is a strong correlation between higher percentage of Hispanic population and a state's liver disease mortality rate (r = 0.538, P < .001). Lower household income (r = 0.405, P = .003) was also associated with the higher liver disease mortality. While there was a trend between higher obesity rates and higher liver disease mortality, the correlation was not strong and there was no clear association between alcohol consumption and liver disease mortality rates.

Keywords: Cirrhosis; Death; Geographic variability; Liver disease; Population-based factors.

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Conflict of interest statement

All authors report that no conflicts of interest exist.

Figures

Figure 1
Figure 1
Significant inter-state variability exists in liver disease related mortality. States color and height represent liver disease mortality
Figure 2
Figure 2
Box plots of displaying rates of (a) viral hepatitis, (b) alcohol consumption, (c) obesity, (d) Hispanic ethnicity and (e) median household income (y-axis) by quartile of liver diseaserelated mortality (x-axis). Q1 = lowest quartile, Q4 = highest quartile.
Figure 3
Figure 3
Population-weight average rates of each race category (y-axis) by quartile of liver disease-related mortality (x-axis). Q1 = lowest quartile, Q4 = highest quartile. Note the varying y-axis values.
See this image and copyright information in PMC

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