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Reported Cirrhosis Mortality -- United States, 1970-1980

According to mortality data from the National Center for Health Statistics (NCHS), from 1970 through 1980,* 19,325,506 people died in the United States. Of these deaths, 347,023 were attributed to liver cirrhosis.** Alcohol was mentioned as a contributing factorS on an average of 40% of all death certificates that reported liver cirrhosis as the underlying cause of death. However, many experts estimate that alcohol abuse is associated with 90%-95% of cirrhosis deaths, and they use cirrhosis mortality as an indicator of abusive alcohol consumption patterns (1).

Cirrhosis mortality in the United States increased steadily following the end of Prohibition (1933) until 1973, when the age-adjusted rate of death peaked at 15.0 per 100,000 population (Figure 2). A steady decrease ensued until 1979, when the age-adjusted mortality rate dropped to 12.1/100,000. However, in 1980, the age-adjusted rates increased slightly. These recent patterns in cirrhosis mortality parallel those of the U.S. age-adjusted death rates from all causes, which declined by approximately 6.5% from 1973 to 1979 and rose 1.7% between 1979 and 1980.

Since 1950, four International Classification of Diseases' schemes have been used to codify cirrhosis deaths. In each revision, liver cirrhosis deaths were classified either as specifically alcohol-related or not specified. Although both categories contributed in the rising mortality trends during the 1950s and 1960s, it is clear that each component of cirrhosis mortality has not contributed equally proportionately to the overall decline beginning in 1973. The crude mortality rate associated with the category of cirrhosis without mention of alcohol declined 20% between 1973 (9.8/100,000) and 1980 (7.8/100,000). The crude rates for alcohol-related cirrhosis mortality have remained relatively stable during the same period. The rate of alcohol-related cirrhosis in 1980 was 5.7/100,000, a reduction of only 5% since 1973.

Rates of death from cirrhosis have been consistently greater for males than for females, regardless of race, since the advent of death registration in 1900. Between 1950 and 1980, the age-adjusted rates for males have often exceeded those for females by 50%. The most dramatic change in cirrhosis mortality since 1950 occurred among nonwhite males, whose rate increased fourfold between 1950 and 1973 (Figure 3). Age-adjusted death rates for nonwhite females, white males, and white females also rose during this same period but not as sharply. Even though mortality from liver cirrhosis has consistently declined since 1973, rates among nonwhite males remain substantially higher than levels of the three other race-sex groups. Consistent with overall age-adjusted cirrhosis death rates, cirrhosis mortality in each race-sex group suggests a general pattern of stabilization after 1979.

Statistics for the 10% sample of mortality reported by NCHS for 1981-1983, however, appear to indicate a further decline in liver cirrhosis mortality (2,3) rather than stabilization. The overall age-adjusted death rates from cirrhosis were 11.4/100,000, 10.4/100,000, and 10.4/100,000 based on the mortality sample for 1981, 1982, and 1983, respectively. This compared with 12.1/100,000 in 1979 and 12.2/100,000 in 1980. This comparison must, however, be viewed with caution. First, estimates from the 10% sample may differ from the final mortality statistics. In addition, unlike those for 1950 through 1980, the population figures used in calculating rates for 1981-1983 are based on postcensal extrapolation rather than intercensal estimation. At this time, it is too soon to determine whether the decline of liver cirrhosis mortality in the current decade will continue. Reported by BF Grant, PhD, SS Aitken, Alcohol Epidemiologic Data System, CSR, Incorporated, Washington, DC; J Noble, H Malin, National Institute on Alcohol Abuse and Alcoholism, Div of Biometry and Epidemiology; Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Recent literature has included several reports of the decline in cirrhosis mortality (4,5). Since overall cirrhosis mortality is declining, the more rapid decline in cirrhosis deaths without mention of alcohol may reflect a true decrease in cirrhosis deaths from causes other than alcohol. It may also reflect a greater willingness on the part of physicians to designate such deaths as alcohol-related. This would accelerate a decrease in rate from this cause, while decelerating the decline in alcohol-related mortality.

References

  1. EP Noble. Third special report to the U.S. Congress on alcohol and health. Washington, D.C.: Department of Health, Education, and Welfare, 1978; DHEW publication no. (ADM)79-832.

  2. National Center for Health Statistics. Advance report of final mortality statistics, 1981. Hyattsville, Maryland: Public Health Service, 1984; DHHS publication no. (PHS)84. (Monthly vital statistics report; vol. 33; no. 3, supp.).

  3. National Center for Health Statistics. Annual summary of births, deaths, marriages, and divorces. Hyattsville, Maryland: Public Health Service, 1984; DHHS publication no. (PHS)84-1120. (Monthly vital statistics report; vol. 32; no. 13).

  4. Department of Health and Human Services. Fourth special report to the U.S. Congress on alcohol and health. Washington, D.C.: Department of Health and Human Services, 1981; DHEW publication no. (ADM)81-1080.

  5. Wilson RA. Changing validity of the cirrhosis mortality--alcoholic beverage sales construct: U.S. trends, 1970-1977. J Stud Alcohol 1984;45:53-8. *The last year for which complete mortality data and census population figures were available. **International Classification of Diseases, 8-rubric (ICD-8), and International Classification of Diseases, 9-rubric (ICD-9). SICD 8-rubric 571.0; ICD 9-rubric 571.0, 571.1, 571.2, and 571.3.



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