Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA Netw Open. 2022 Jun 1;5(6):e2219170. doi: 10.1001/jamanetworkopen.2022.19170.
US hepatitis B mortality has been described nationally, but examination subnationally may identify differences in mortality rates and decedent characteristics, including birthplace.
To examine characteristics of decedents with hepatitis B-listed deaths during 2010 to 2019 and compare age-adjusted hepatitis B-listed death rates during 2010 to 2019 vs 2000 to 2009.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Multiple Cause of Death data from 50 US states and the District of Columbia (DC) from 2000 to 2019 to assess characteristics of US residents with hepatitis B listed as an underlying cause of death (UCOD) or contributing cause of death on death certificates. Data were analyzed from September 2019 to May 2022.
Hepatitis B listed as underlying or contributing cause of death.
Outcomes of interest were hepatitis B-listed death counts, age-adjusted rates, and characteristics of decedents during 2000 to 2019. The distribution of hepatitis B-listed deaths according to sociodemographic characteristics and UCOD among US- and non-US-born decedents were also examined.
A total of 35 280 decedents with hepatitis B listed as the cause of death were identified, including 17 483 deaths during 2010 to 2019. Decedents were 63.3% US-born, and 25.8% of decedents were Asian or Pacific Islander and 46.5% of decedents were White; 28.4% of decedents were listed as having hepatitis C virus (HCV) or HIV coinfection. State-level rates significantly surpassed the overall US rate (0.47 deaths per 100 000 population) in DC (high, 1.78 deaths per 100 000 population), Hawaii, Oklahoma, California, Tennessee, West Virginia, Mississippi, Oregon, Washington, Louisiana, Kentucky, and New York (low, 0.61 deaths per 100 000 population). Median (IQR) age at hepatitis B death was significantly younger in Kentucky (54.0 [46.0-64.0] years), West Virginia (56.0 [47.0-65.0] years), Tennessee (57.0 [50.0-65.0] years), Mississippi (58.0 [50.0-65.0] years), and Ohio (59.0 [50.0-66.0] years) than the national median (60.0 [53.0-69.0] years), which itself was significantly younger than nonhepatitis B-listed deaths (77 [63.0-87.0] years; P < .001). Hepatitis B was the UCOD among approximately 30% of US- and non-US-born decedents with hepatitis B COD. Irrespective of birthplace, most decedents had liver-related UCOD. Compared with non-US-born decedents, US-born decedents more frequently had nonliver conditions listed as UCOD. Liver cancer was the predominant UCOD among non-US-born decedents (37.9% of decedents). From 2000 to 2009 compared with 2010 to 2019, the hepatitis B-listed mortality rate significantly decreased nationally (change, -18.97%) and in 14 states; significant increases were observed in West Virginia (change, 83.78%) and Kentucky (change, 69.44%).
These findings suggest that US-born decedents constituted two-thirds of all hepatitis B-listed deaths and median age at death was youngest in Appalachian states. Irrespective of birthplace, most decedents had liver-related UCOD; however, US-born decedents more frequently had nonliver UCOD than non-US-born decedents. In addition to addressing liver-related complications, US-born persons with chronic infection may also require diagnosis and management of multiple comorbidities.
美国乙型肝炎死亡率已在全国范围内进行了描述，但亚国家层面的检查可能会发现死亡率和死者特征的差异，包括出生地。
检查 2010 年至 2019 年期间乙型肝炎死亡列表中死者的特征，并比较 2010 年至 2019 年与 2000 年至 2009 年期间乙型肝炎死亡列表的年龄调整死亡率。
设计、地点和参与者：这项横断面研究使用了来自美国 50 个州和哥伦比亚特区（DC）的 2000 年至 2019 年的多死因数据，以评估乙型肝炎被列为主要死因（UCOD）或死亡证明上的次要死因的美国居民的特征。数据于 2019 年 9 月至 2022 年 5 月进行分析。
乙型肝炎被列为主要或次要死因。
感兴趣的结果是 2000 年至 2019 年期间乙型肝炎死亡人数、年龄调整率以及死者的特征。还检查了根据社会人口特征和美国出生与非美国出生死者的 UCOD 分布情况。
共确定了 35280 名乙型肝炎死亡列表中的死者，其中包括 2010 年至 2019 年期间的 17483 例死亡。死者中 63.3%为美国出生，25.8%为亚洲或太平洋岛民，46.5%为白人；28.4%的死者被列为丙型肝炎病毒（HCV）或人类免疫缺陷病毒（HIV）合并感染。州一级的死亡率明显高于美国总体死亡率（每 10 万人中有 0.47 人死亡），其中包括哥伦比亚特区（高，每 10 万人中有 1.78 人死亡）、夏威夷、俄克拉荷马州、加利福尼亚州、田纳西州、西弗吉尼亚州、密西西比州、俄勒冈州、华盛顿州、路易斯安那州、肯塔基州、肯塔基州和纽约州（低，每 10 万人中有 0.61 人死亡）。肯塔基州（54.0[46.0-64.0]岁）、西弗吉尼亚州（56.0[47.0-65.0]岁）、田纳西州（57.0[50.0-65.0]岁）、密西西比州（58.0[50.0-65.0]岁）和俄亥俄州（59.0[50.0-66.0]岁）的乙型肝炎死亡患者的中位年龄（IQR）明显低于全国中位数（60.0[53.0-69.0]岁），而乙型肝炎死亡患者的中位年龄又明显低于非乙型肝炎死亡患者（77[63.0-87.0]岁；P<0.001）。乙型肝炎是大约 30%的美国出生和非美国出生的乙型肝炎死因患者的 UCOD。无论出生地如何，大多数死者的死因与肝脏有关。与非美国出生的死者相比，美国出生的死者更常见的死因是非肝脏疾病。肝癌是最主要的非美国出生死者的 UCOD（占死者的 37.9%）。与 2000 年至 2009 年相比，2010 年至 2019 年，乙型肝炎死亡列表的死亡率在美国全国范围内（下降 18.97%）和 14 个州均显著下降；西弗吉尼亚州（上升 83.78%）和肯塔基州（上升 69.44%）的死亡率显著上升。
这些发现表明，美国出生的死者占所有乙型肝炎死亡人数的三分之二，死亡时的中位年龄在阿巴拉契亚州最低。无论出生地如何，大多数死者的死因与肝脏有关；然而，与非美国出生的死者相比，美国出生的死者更常见的死因是非肝脏疾病。除了治疗与肝脏有关的并发症外，慢性感染的美国患者可能还需要诊断和治疗多种合并症。
