HBV-listed death rates surpass national average in coastal, Appalachian states
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Individuals born in the United States made up nearly two-thirds of all hepatitis B-listed deaths, with death rates exceeding the national average in 13 states, according to research published in JAMA Network Open.
“Annual national viral hepatitis surveillance reports have included hepatitis B mortality estimates since 2004, displaying state-level data since 2015. However, these reports lacked
information on decedent place of birth, comorbidities and underlying vs. contributing causes of death,” Kathleen N. Ly, MPH, of the division of viral hepatitis at the CDC National Center for HIV, Viral Hepatitis, STD and TB Prevention, and colleagues wrote. “To further explore differences between U.S.- and non-U.S.-born decedents with hepatitis B-listed deaths, we examined the distribution of these deaths by sociodemographic characteristics, median age at death and [underlying cause of death].”
Using multiple cause of death data from 50 U.S. states and the District of Columbia, Ly and colleagues performed a cross-sectional analysis of HBV-listed deaths from 2000 to 2019 and identified 35,280 HBV-listed deaths, which included 17,483 deaths between 2010 and 2019. Further baseline analysis showed 63.3% of patients were born in the U.S., 73.1% were men, 46.5% were white and 28.4% had hepatitis C or HIV coinfection.
Death rates in 13 states exceeded the national mean number of all HBV-listed deaths (mean 343 deaths per state) with California accounting for 20.4% of deaths and New York (8%), Texas (8%) and Florida (6.2%) following with more than 1,000 deaths each. Washington, D.C., significantly surpassed the overall U.S. rate (1.78 deaths per 100,000 population vs. 0.47 deaths per 100,000 population).
Compared with the national median age at HBV-listed death (60 years) and national median age at non-HBV-listed death (77 years), researchers reported younger ages at HBV-listed death in Kentucky (54 years), West Virginia (56 years), Tennessee (57 years), Mississippi (58 years) and Ohio (59 years).
Overall, HBV was identified as the underlying cause of death (UCOD) among approximately 30% of U.S.- and non-U.S.-born decedents. The most frequently listed UCOD was HBV (30.2%), followed by liver cancer (14.4%) and non-liver cancers (11.4%) among U.S.-born decedents; the most frequently listed UCOD was liver cancer (37.9%) followed by HBV (29.4%) and non-liver cancers (11.7%) among decedents not born in the U.S.
When comparing mortality rates from 2000 to 2009 vs. 2010 to 2019, researchers observed an 18.97% decrease nationally and in 14 states, but an 83.78% and 69.44% increase in West Virginia and Kentucky, respectively.
“The findings of this cross-sectional study suggest that in addition to diagnosis and management of hepatitis B among non-U.S.-born persons, U.S.-born persons with chronic infection, who constituted approximately two-thirds of all hepatitis B-listed deaths, may also require diagnosis and management of viral coinfections, respiratory and cardiovascular conditions, nonviral liver disease and addiction-related sequelae,” Ly and colleagues concluded. “Further reduction of hepatitis B mortality will require access to hepatitis B-related care that is continual and lifelong.”
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