Underestimation of liver‐related mortality in the United States
Open accessAbstract
Background & aims According to the National Center for Health Statistics (NCHS), chronic liver disease and cirrhosis is the 12(th) leading cause of death in the United States. However, this single descriptor might not adequately enumerate all deaths from liver disease. The aim of our study was to update data on liver mortality in the United States.Methods Mortality data were obtained from the Rochester Epidemiology Project (1999-2008) and the National Death Registry (1979-2008). Liver-specific mortality values were calculated. In contrast to the narrow NCHS definition, updated liver-related causes of death included other specific liver diagnoses (eg, hepatorenal syndrome), viral hepatitis, and hepatobiliary cancers.Results The Rochester Epidemiology Project database contained information on 261 liver-related deaths, with an age- and sex-adjusted death rate of 27.0/100,000 persons (95% confidence interval: 23.7-30.3). Of these, only 71 deaths (27.2%) would have been captured by the NCHS definition. Of cases for which viral hepatitis or hepatobiliary cancer was the cause of death, 96.9% and 94.3% had liver-related immediate causes of death, respectively. In analysis of data from the National Death registry (2008), use of the updated definition increased liver mortality by >2-fold (from 11.7 to 25.7 deaths/100,000, respectively). Using NCHS definitions, liver-related deaths decreased from 18.9/100,000 in 1979 to 11.7/100,000 in 2008-a reduction of 38%. However, using the updated estimate, liver-related deaths were essentially unchanged from 1979 (25.8/100,000) to 2008 (25.7/100,000). Mortality burden was systematically underestimated among non-whites and persons of Hispanic ethnicity.Conclusions Based on analyses of the Rochester Epidemiology Project and National Death databases, liver-related mortality has been underestimated during the past 2 decades in the United States.
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Evidence to support integrated behavioral health for patients with chronic liver disease is limited.
“However, evidence to support integrated behavioral health for patients with chronic liver disease (CLD) is limited.4”
From A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease (2019) · cites this paper as [4]
The Discussion (page not provided) addresses underestimation of liver-related mortality and its implications for care, not the evidence for integrated behavioral health. Searches for integrated behavioral health and related mental-health terms found no passage assessing whether evidence for that approach in chronic liver disease is limited. (LLM, conf=0.76)
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- Authors
- Asrani, S. K., Larson, J. J., Yawn, B., Therneau, T. M., & Kim, W. R.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Kim, W. Ray
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 145
- Issue
- 2
- Pages
- 375-382.e2
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC3890240
- OpenAlex
- W2079748214
- Cited by
- 311
- References
- 45
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 17 · 2023: 30 · 2022: 25 · 2021: 29 · 2020: 27 · 2019: 23 · 2018: 34 · 2017: 28 · 2016: 23 · 2015: 24 · 2014: 23 · 2013: 8
- FWCI
- 16.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (K24DK-92336, R01DK-34238, T32 DK07198)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- liver-related mortality, chronic liver disease, liver cirrhosis, mortality underestimation, cause of death classification, viral hepatitis, hepatobiliary cancer, hepatorenal syndrome, racial and ethnic disparities, Rochester Epidemiology Project
- MeSH terms
- Adult, Aged, Cause of Death, Female, Hepatic Encephalopathy, Hepatitis, Viral, Human, Carcinoma, Hepatocellular, Hepatorenal Syndrome, Humans, Liver Cirrhosis, Liver Diseases, Liver Neoplasms, Male, Middle Aged, Minnesota, National Center for Health Statistics, U.S., United States
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