(Abstract #269) Mortality due to Chronic Liver Disease among American Indians and Alaska Natives in the United States, 1999–2009
Authors: B. J. McMahon*; A. Suryaprasad; K. K. Byrd; J. T. Redd; D. G. Perdue; M. Manos
Note:
this is the original abstract from the AASLD website
Background and Aims:
Chronic liver disease (CLD) is a
leading cause of death among American Indian and Alaska Natives
Peoples (AI/ANs). The precision of mortality estimates, however, is
limited by the underestimation of chronic liver disease cases with
narrow definitions in mortality data and the misclassification of
AI/ANs in death records.
We employed a
previously-validated definition of chronic liver disease deaths, based
on comprehensive diagnostic disease codes, and used techniques to
improve American Indian and Alaska Natives Peoples race classification
to describe disparities and compare trends in chronic liver disease
mortality during 1999–2009 between American Indian and Alaska Natives
Peoples in the United States.
Methods:
Chronic Liver Disease deaths and
causes in American Indian and Alaska Natives Peoples were identified
from death certificates using the comprehensive codes. Chronic liver
disease deaths with a primary liver cancer code were classified as
hepatocellular carcinoma (HCC), and all others classified as cirrhosis.
To improve American Indian and Alaska Natives Peoples race
classification, the National Death Index was linked to Indian Health
Service (IHS) enrollment records and analyses were restricted to
Contract Health Service Delivery Areas, which contain or are adjacent to
federally-recognized tribal reservations. Death rates (per 100,000)
were directly age-adjusted to the 2000 U.S. standard population and
were calculated in six geographic regions. Trends were described using
Joinpoint regression techniques.
Results:
From 1999–2009, chronic liver
disease death rates increased by 24.1% in American Indian and Peoples
and 14.2% in Alaska Native peoples, increasing annually in both
(P-value <0.05). The overall chronic liver disease death rate in
Alaska Natives was 66.1/100,000 (95% Confidence Interval [CI]
64.7–67.6).
The overall CLD death rate ratio
(RR) of Alaska Natives to non-Hispanic whites was 3.7 (95% CI 3.7–3.8)
and varied across regions.
The death rate ratio was greater
in females (4.7, 95% CI 4.6–4.9), ages 25–44 years (7.4, 95% CI
7.1–7.8), Northern Plains residents (6.4, 95% CI 6.1–6.8), and persons
dying with cirrhosis (4.0, 95% CI 3.9–4.1) versus hepatocellular
carcinoma (2.5, 95% CI 2.3–2.7), particularly in ages 25–44 years (7.7,
95% CI 7.3–8.1).
Cirrhosis-related chronic liver
disease death rates were significantly higher in American Indians and
Alaska Natives than non-Hispanic whites for deaths with underlying
alcoholic liver disease (RR 5.2, 95% CI 5.0–5.4), hepatitis C (RR 2.5,
95% CI 2.3–2.7), and hepatitis B (RR 2.4, 95% CI 1.9–3.1).
Conclusions:
Chronic liver disease mortality
is nearly four times greater in Alaska Natives and American Indians than
non-Hispanic whites. Death rate disparities were greatest among
cirrhosis deaths, compared to hepatocellular carcinoma (liver cancer)
deaths and greater in females and Northern Plains residents. The
disparity in premature chronic liver disease mortality between American
Indians/Alaska Natives and non-Hispanic whites is especially
concerning. These findings can guide resource allocation that is
urgently needed for comprehensive prevention and care strategies, to
stem the chronic liver disease epidemic in this population.
Labels: Alaska, chronic liver disease, mortality, Native Peoples, statistics