Khatana SAM, Goldberg DS, et al. - Changes in economic prosperity at the county level, independent of other clinical, demographic, and access-to-care variables, may play a role in population-level trends in liver disease-related deaths among the working-age population.

• The authors used county-level mortality data from the Centers for Disease Control and Prevention, economic prosperity measures from the Distressed Communities Index, and county-level markers of demographics, risk factors for liver disease, and access to healthcare to conduct a retrospective cohort study.

• There was an inverse association between changes in county-level economic prosperity and changes in county-level age-adjusted liver disease-related mortality rates (for example, counties with the smallest increase in economic prosperity had the largest annual increase in liver disease-related mortality).

• There was a significant association between economic prosperity and liver disease-related mortality in generalized linear mixed models that took county-level covariates into account; that is, for every 10-point increase in mean rank for change in economic prosperity, there was an additional 0.65% decrease in mortality per year.