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Liver disease mortality highest in U.S. southwest, Hispanic populations

Liver disease-related mortality rates varied significantly by geographic region in the Untied States with some of the highest rates in the South and the West, in areas with higher Hispanic populations, and areas of lower household income, according to a recently published study.

“We sought to determine whether there was geographic variability in liver disease-related mortality rates at the state level in the United States,” Archita P. Desai, MD, from the University of Arizona, and colleagues wrote. “Differences in death rates among various demographic sub-populations may be due to differences in genetic predisposition or due to social factors such as socioeconomic status, access to medical care, and the prevalence of specific risk factors in a particular subpopulation.”

Age-adjusted liver disease-related mortality ranged from 6.4 per 100,000 to 17 per 100,000 across the U.S. The lowest rates were in the northeast, including New Hampshire (6.4 per 100,000) and New York (6.6 per 100,000). In contrast, the highest rates were in the west and central southwest, including Arizona (12.7 per 100,000) and New Mexico (17 per 100,000).

Mortality rates related to viral hepatitis ranged from the lowest in Wisconsin (1%) to the highest in Delaware (5.9%) Hepatitis-related mortality correlated significantly with rates of liver disease-related mortality, increasing from 2% in states in the lowest quartile to 3.1% in the highest quartile (r = 0.55; P < .0001).

Seven of the thirteen states in the highest quartile of liver disease-related mortality reported a higher than average Hispanic population (r = 0.538; P < .001). Additionally, states in the highest quartile of liver disease-related mortality had the highest rates of racial diversity.

“This is largely due to a significant increase in the proportion of individuals reporting ‘other’ as their race in states in the highest quartile of liver disease mortality,” the researchers noted.

Median household income also correlated significantly with higher rates of liver disease-related mortality (r = 0.405; P = .003). Nine of the 13 states in the highest quartile of liver disease-related mortality had a lower median income, whereas six of the 13 states in the lowest quartile had the highest median income.

While rates of alcohol consumption and obesity ranged across the U.S., the researchers observed no significant correlation between these rates and rates of liver disease-related mortality.

“Our study found that ethnicity, race, and income correlated with liver disease mortality but do not fully explain the geographic variability of liver disease mortality, as exceptions to the relationship exist,” the researchers wrote. “We suspect that factors such as employment status, educational level, health insurance status, community socioeconomic status (income), access to health care and subspecialty care may all be associated with liver disease mortality through various pathways.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.