The incidence of death due to liver-related causes has been underestimated in the US for decades, according to recent results.
Researchers evaluated data on liver-related mortality collected from the National Death Registry (NDR) between 1979 and 2008 and from the Rochester Epidemiology Project (REP), which includes information on the population of Olmsted County, Minn. (n=144,248 in 2010) between 1999 and 2008. Results according to an updated definition of liver-related causes of death that includes viral hepatitis, hepatobiliary cancer and other specific diagnoses, were compared with those defined by the CDC’s National Center for Health Statistics (NCHS).
Using the updated definition, 261 liver-related deaths were collected from the REP database, for a calculated mortality rate of 27 per 100,000 persons after adjustment for age and sex. The NCHS definition of liver-related death accounted for 71 of these deaths. Investigators said among patients who died because of viral hepatitis or hepatobiliary cancer, liver-related issues were considered the immediate cause of death in 96.9% and 94.3% of patients, respectively.
Analysis of NDR data indicated an increase from 11.7 deaths per 100,000 persons in 2008, according to the NCHS definition, to 25.7 per 100,000 using the updated definition. Application of the NCHS definition indicated a 38% decrease in liver-related death between 1979 and 2008 (11.7 deaths per 100,000 persons compared with 18.9), while the updated definition showed almost no change for that period (25.7 per 100,000 in 2008 vs. 25.8 in 1979).
The increase in liver-related mortality according to the new definition varied by race. Among white patients, 47% of liver-related deaths accounted for in the new definition met the NCHS definition, compared with 48% among Hispanics, 34.3% among African-Americans and 20% among Asians.
“The results of this analysis highlight the importance of liver disease as a leading cause of death in the US,” the researchers concluded. “Liver-related mortality … is underestimated, in part, as a result of incomplete ascertainment of liver-related deaths. These data support that deaths due to viral hepatitis and hepatobiliary cancers should be included in the enumeration of liver-related deaths to accurately represent the burden of chronic liver disease.”