Paik James M, Henry Linda, De Avila Leyla, Younossi Elena, Racila Andrei, Younossi Zobair M
Betty and Guy Beatty Center for Integrated Research Inova Health System Falls Church VA.
Center for Outcomes Research in Liver Diseases Washington DC.
Hepatol Commun. 2019 Aug 14;3(11):1459-1471. doi: 10.1002/hep4.1419. eCollection 2019 Nov.
Population-level nonalcoholic fatty liver disease (NAFLD) death rate data are sparse. We described death rates for adults with NAFLD in the United States using mortality data from the National Vital Statistics System multiple-cause mortality data (2007-2016). Decedents who had NAFLD were identified by International Classification of Diseases (ICD) codes K75.81, K76.0, K74.0, K74.6, and K76.9. Among NAFLD decedents, cause-specific deaths (e.g., cardiovascular disease [CVD], cirrhosis, hepatocellular carcinoma [HCC], non-liver cancer, diabetes mellitus [DM]) were identified by underlying cause of death ICD-10 codes. Trends were evaluated by average annual percentage change (AAPC) in age-standardized death rate (ASDR) per 100,000 persons. Among the 25,129,960 decedents aged ≥20 years, 353,234 (1.4%) decedents had NAFLD (212,322 men; 260,765 non-Hispanic whites, 32,868 non-Hispanic blacks, 46,530 Hispanics, 5,025 non-Hispanic American Indian or Alaska Natives [AIANs], 7,023 non-Hispanic Asian or Pacific Islanders [APIs]), with a mean age at death of 64.47 ± 13.17 years. During the study period, the ASDR for NAFLD increased by 15% (12.94 to 14.90; AAPC, 1.98%; < 0.001]), while women (AAPC, 2.99% vs. 1.16% men; = 0.003), non-Hispanic whites (AAPC, 2.48%), non-Hispanic AIANs (AAPC, 2.31%), and Hispanics (AAPC, 0.74%) experienced the highest annual increases. Stable trends were noted for non-Hispanic blacks and non-Hispanic APIs. Among subgroups, Mexican (AAPC, 1.75%) and Asian Indians (AAPC, 6.94%) experienced annual increases. The top six underlying causes of death (155,894 cirrhosis, 38,444 CVD, 19,466 non-liver cancer, 10,867 HCC, 8,113 DM, and 5,683 lung disease) accounted for 67.5% of NAFLD-related deaths. For cause-specific deaths, ASDR increased for HCC (AAPC, 3.82%), DM (AAPC, 2.23%), non-liver cancer (AAPC, 2.14%), CVD (AAPC, 1.59%), and cirrhosis (AAPC, 0.96%). NAFLD-related deaths in U.S. adults are increasing. Cirrhosis is the top cause-specific death, followed by CVD. Women, non-Hispanic whites, and non-Hispanic AIANs (subgroups Mexicans and Asian Indians) experienced the highest increases in deaths. Policies addressing the societal burden of NAFLD are needed.
人群层面的非酒精性脂肪性肝病（NAFLD）死亡率数据较为匮乏。我们利用国家生命统计系统的多病因死亡率数据（2007 - 2016年）描述了美国NAFLD成年患者的死亡率。患有NAFLD的死者通过国际疾病分类（ICD）编码K75.81、K76.0、K74.0、K74.6和K76.9来确定。在NAFLD死者中，特定病因死亡（如心血管疾病[CVD]、肝硬化、肝细胞癌[HCC]、非肝癌、糖尿病[DM]）通过死亡根本原因的ICD - 10编码来确定。趋势通过每10万人年龄标准化死亡率（ASDR）的年均百分比变化（AAPC）进行评估。在25,129,960名年龄≥20岁的死者中，353,234名（1.4%）死者患有NAFLD（212,322名男性；260,765名非西班牙裔白人、32,868名非西班牙裔黑人、46,530名西班牙裔、5,025名非西班牙裔美国印第安人或阿拉斯加原住民[AIANs]、7,023名非西班牙裔亚裔或太平洋岛民[APIs]），平均死亡年龄为64.47±13.17岁。在研究期间，NAFLD的ASDR增加了15%（从12.94增至14.90；AAPC为1.98%；<0.001），而女性（AAPC为2.99%，男性为1.16%；P = 0.003）、非西班牙裔白人（AAPC为2.48%）、非西班牙裔AIANs（AAPC为2.31%）和西班牙裔（AAPC为0.74%）的年增幅最高。非西班牙裔黑人和非西班牙裔APIs的趋势保持稳定。在亚组中，墨西哥人（AAPC为1.75%）和亚洲印度人（AAPC为6.94%）出现了年度增长。前六大死亡根本原因（155,894例肝硬化、38,444例CVD、19,466例非肝癌、10,867例HCC、8,113例DM和5,683例肺病）占NAFLD相关死亡的67.5%。对于特定病因死亡，HCC（AAPC为3.82%）、DM（AAPC为2.23%）、非肝癌（AAPC为2.14%）、CVD（AAPC为1.59%）和肝硬化（AAPC为0.96%）的ASDR有所增加。美国成年患者中与NAFLD相关的死亡人数正在增加。肝硬化是特定病因死亡的首要原因，其次是CVD。女性、非西班牙裔白人以及非西班牙裔AIANs（亚组中的墨西哥人和亚洲印度人）的死亡增幅最高。需要制定应对NAFLD社会负担的政策。
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