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Cirrhosis-related mortality rates increasing in U.S. since 2009

Cirrhosis-related mortality increased in the U.S. since 2009 with rates varying by age, ethnicity and region, according to a recently published report.

“Projected increases in the burden of cirrhosis are thought to be driven primarily by the increasing prevalence of alcoholic liver disease and non-alcoholic fatty liver disease,” Elliot B. Tapper, MD, and Neehar D. Parikh, MD, from the University of Michigan, wrote. “The incidence and impact of cirrhosis related complications is uneven across the USA, with substantial geographic and demographic variability.”

To evaluate the trends of cirrhosis-related mortality from 1999 to 2016, Tapper and Parikh obtained data from the CDC WONDER platform. Additionally, the authors gathered data on hepatocellular carcinoma mortality rates.

During the study period, deaths attributed to cirrhosis increased from 20,661 cases in 1999 to 34,174 cases in 2016. Deaths attributed to HCC increased from 5,112 in 1999 to 11,073 in 2016.

Age-adjusted mortality was higher in men than women for both cirrhosis (2:1) and HCC (4:1).

Age-adjusted mortality due to cirrhosis was highest in Native Americans (25.8 per 100,000) and white individuals (12.7 per 100,000), whereas HCC mortality rates were highest among Asian and Pacific Islander individuals.

The south (13.5 per 100,000) and west (13.3 per 100,000) regions of the U.S. had the highest age-adjusted mortality rates for cirrhosis. HCC rates remained highest in the west (4.2 per 100,000).

Compared with other age groups, adults aged 25 years to 34 years had the highest average annual percentage change in mortality due to cirrhosis: 3.7% over the study period and 10.5% between 2009 and 2016.

The average annual percentage change for cirrhosis-related mortality due to peritonitis (1.5%; 95% CI, 0.2-2.8) and sepsis (3.7%; 95% CI, 3.2-4) increased significantly across all age groups. The authors found no significant changes for comorbid upper gastrointestinal hemorrhage, hepatorenal syndrome, cerebrovascular and ischemic heart disease, or trauma.

Deaths due to alcoholic cirrhosis increased the most in Louisiana (13.1%; 95% CI, 7.7-18.9), California (12.9%; 6.7-19.5), Kentucky (12.8%; 9.8-15.8), Delaware (9.8%; 5.1-14.7) and New Mexico (9.3%; 95% 6.3-12.4) over the study period, whereas Washington, D.C., and Maryland showed improvements in mortality.

“The increasing mortality due to cirrhosis and hepatocellular carcinoma speak to the expanding socioeconomic impact of liver disease,” Tapper and Parikh wrote. “Understanding the factors associated with mortality due to these conditions will inform how best to allocate resources.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.