Progress in Chronic Disease Prevention Chronic Disease Reports: Deaths from Chronic Liver Disease -- United States, 1986

In 1986, 26,151 persons died with an underlying diagnosis of chronic liver disease and cirrhosis (chronic liver disease, International Classification of Diseases, Ninth Revision (ICD-9), code 571) (Table 1). Chronic liver disease was a contributing cause in an additional 13,475 deaths (1). Among deaths for which chronic liver disease was the underlying cause, 42% were diagnostically associated with alcohol (e.g., alcoholic cirrhosis of the liver and alcoholic liver damage, unspecified) (ICD-9 571.0-571.3); 3%, with chronic hepatitis (ICD-9 571.4); 1%, with biliary cirrhosis (ICD-9 571.6), and 53%, with unspecified conditions and no mention of alcohol (ICD-9 571.5, 571.8, 571.9) (2).

Forty-eight percent of deaths from chronic liver disease occurred in persons aged less than 60 years (2); chronic liver disease accounted for 2% of years of potential life lost before age 65 (3). Rates of chronic liver disease mortality were highest among persons aged 65-74 years (51.9 per 100,000 males and 25.8 per 100,000 females). When adjusted for age, mortality from chronic liver disease was 2.3 times higher in males than in females and 1.7 times higher in blacks than in whites (4).

The highest rates of chronic liver disease mortality in 1986 (age-adjusted to the 1986 U.S. population) occurred in southwestern states and in California, Delaware, the District of Columbia, Florida, Illinois, Massachusetts, Michigan, New Jersey, and New York (Table 2, Figure 1). Arkansas had the lowest rate (5.9 per 100,000) and the District of Columbia, the highest (30.9 per 100,000). Reported by: Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office; Hepatitis Br, Div of Vial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Risk factors for chronic liver disease include drug and occupational exposures; infection with hepatitis B virus; parenterally transmitted non-A, non-B hepatitis virus; and other diseases (5,6). Consumption of alcoholic beverages is a well-established risk factor for cirrhosis (7); risk of cirrhosis mortality increases with the amount of alcohol consumed and the duration of elevated consumption (8). Other environmental or genetic factors can also play a role in the development of cirrhosis (9).

Average daily consumption of greater than or equal to 1 oz. of ethanol (approximately two drinks of wine, beer, or spirits) is regarded as "heavy drinking" (7). Based on recent rates of heavy drinking (4) and a risk of cirrhosis mortality seven times higher in heavy drinkers than in nonheavy drinkers (recalculated from (10)), at least 15% of cirrhosis mortality among females and 46% of cirrhosis mortality among males is attributable to heavy drinking. Thus, the reduction of heavy alcohol consumption remains an important means for the control of cirrhosis mortality.

References

1. NCHS. Vital statistics mortality data, multiple cause of

death detail, 1986 (machine-readable public-use data tape). Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1988.

2. NCHS. Vital statistics of the United States, 1986. Vol II--Mortality, pt. A. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1988; DHHS publication no. (PHS)88-1122.

3. CDC. Years of potential life lost before age 65--United States, 1987. MMWR 1989;38:27-9.

4. CDC. Health, United States, 1988. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (PHS)89-1232.

5. Sherlock S. Diseases of the liver and biliary system. 7th ed. Boston: Blackwell Scientific Publications, 1985.

6. Alter HJ. The chronic consequences of non-A, non-B hepatitis. In: Seeff LB, Lewis JH, eds. Current perspectives in hepatology. New York: Plenum Medical Book, 1989:83-97.

7. National Institute on Alcohol Abuse and Alcoholism. Alcohol and health. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (ADM)87-1519.

8. Lelbach WK. Cirrhosis in the alcoholic and its relation to the volume of alcohol abuse. Ann N Y Acad Sci 1975;252:85-105.

9. Grant BF, Dufour MC, Harford TG. Epidemiology of alcoholic liver disease. Semin Liver Dis 1988;8:12-25. 10. Klatsky AL, Friedman GD, Siegelaub AB. Alcohol and mortality: a ten-year Kaiser-Permanente experience. Ann Intern Med 1981;95:139-45.

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