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
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.
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.).
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).
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.
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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