Tapper EB, et al. - Researchers analyzed liver disease-related mortality in the US from 1999-2016 by age group, sex, race, cause of liver disease, and geographic region. They found that mortality due to cirrhosis has been increasing in the US since 2009. The greatest relative increase in mortality was experienced by people aged 25-34; this increase was driven by deaths due to alcoholic cirrhosis. The greatest increase in deaths from cirrhosis was experienced by White Americans, Native Americans, and Hispanic Americans. Improved mortality due to cirrhosis was reported in Maryland, while it was worst in Kentucky, New Mexico, and Arkansas. Overall, a rapid increase in mortality due to alcohol was reported among young people; this highlights new challenges for optimal care of patients with preventable liver disease.

Methods

• Researchers performed an observational cohort study including US residents.
• They used death certificate data from the Vital Statistics Cooperative, and population data from the US Census Bureau compiled by the Center for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (1999-2016).
• Main outcome measure included deaths from cirrhosis and hepatocellular carcinoma, with trends assessed using joinpoint regression.

Results

• Data showed that annual deaths from cirrhosis increased by 65%, to 34,174 from 1999 to 2016 in the US, while annual deaths from hepatocellular carcinoma doubled to 11,073.
• An improvement in mortality from hepatocellular carcinoma was reported for only one subgroup, Asians and Pacific Islanders, for whom the death rate decreased by 2.7% (95% confidence interval 2.2% to 3.3%, P < 0.001) per year.
• Most pronounced annual increases in cirrhosis related mortality were seen among Native Americans (designated as “American Indians” in the census database) (4.0%, 2.2% to 5.7%, P=0.002).
• Annual increase by 2.1% in age adjusted death rate due to hepatocellular carcinoma was observed (1.9% to 2.3%, P < 0.001); deaths due to cirrhosis began increasing in 2009 through 2016 by 3.4% (3.1% to 3.8%, P < 0.001).
• During 2009-2016, the highest average annual increase in cirrhosis related mortality was observed in people aged 25-34 years (10.5%, 8.9% to 12.2%, P < 0.001), driven entirely by alcohol related liver disease.
• During this period, in the setting of cirrhosis, a substantial increase in the mortality due to peritonitis and sepsis was noted, with respective annual increases of 6.1% (3.9% to 8.2%) and 7.1% (6.1% to 8.4%).
• Improvements in mortality (-1.2%, -1.7% to -0.7% per year) were demonstrated by only one state, Maryland, while disproportionate annual increases were observed by many, concentrated in the south and west: Kentucky 6.8% (5.1% to 8.5%), New Mexico 6.0% (4.1% to 7.9%), Arkansas 5.7% (3.9% to 7.6%), Indiana 5.0% (3.8% to 6.1%), and Alabama 5.0% (3.2% to 6.8%).
• Improvement in hepatocellular carcinoma related mortality was not shown by any state, while the most severe annual increases were reported for Arizona (5.1%, 3.7% to 6.5%) and Kansas (4.3%, 2.8% to 5.8%).