Epidemiology

Rising death rates from hepatitis C-related chronic liver disease

Last Updated: 2004-02-27 16:32:45 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Though chronic liver disease mortality declined slightly, the mortality rates for hepatitis C-related chronic liver disease more than doubled during the 1990s, according to a report in the February issue of Hepatology.

Chronic liver disease (CLD) is the 10th most frequent cause of death in the United States, the authors explain, but the contribution of viral hepatitis to CLD-related mortality has been elusive.

Dr. Sirenda Vong and Dr. Beth P. Bell from Centers for Disease Control and Prevention (CDC), Atlanta, Georgia used an expanded definition of CLD deaths that included death certificates where CLD, viral hepatitis, or CLD-related sequelae were reported to calculate overall age-specific and age-adjusted mortality rates from 1990 through 1998.

The age-adjusted death rate for CLD declined 4.5% (from 12.1 to 11.6/100,000) between 1990 and 1998, the authors report, though rates were stable from 1995 through 1998.

Between 1993 and 1998, hepatitis C-related CLD deaths increased 220%, the report indicates, along with a 45% increase in deaths from unspecified viral hepatitis. Hepatitis B-related CLD deaths remained unchanged from 1990 through 1998.

During this period, deaths from alcohol-related CLD fell by 10.5%, the researchers note, whereas death rates from primary biliary cirrhosis increased by 12.8%.

Age-adjusted death rates in 1998 were highest among American Indians/Alaska Natives (28.7/100,000), the results indicate, followed by African Americans (12.9/100,000), whites (11.5/100,000), and Asians/Pacific Islanders (4.1/100,000). Age-adjusted death rates were more than 1.5 times higher among Hispanics than among non-Hispanics.

"In contrast to reported trends," the investigators write, "the decline in CLD mortality observed during previous decades and sustained through the early 1990s did not continue after 1994, largely because of increases in hepatitis C-related deaths."

"This analysis highlights large disparities in CLD mortality, demonstrating the need for social and public health interventions that target high-risk groups such as American Indians/Alaska Natives and Hispanic Americans," the authors conclude. "Further studies are needed to evaluate the validity of estimates of the mortality burden from CLD generated from national mortality data and to characterize better the causes of CLD deaths."

Hepatology 2004;39:476-483.