Lo Chun-Han, Verma Renuka, Amin Rajan, Manne Vignan, Saab Sammy
Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA.
Division of Gastroenterology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA.
Dig Dis Sci. 2025 Apr 14. doi: 10.1007/s10620-025-08979-z.
Mortality related to alcohol-associated liver disease (ALD) has been increasing over the past two decades, especially in racial and ethnic minorities and those living in rural areas. The interaction between rurality, race and ethnicity in mortality disparities is unclear.
This cross-sectional study extracted data from the Underlying Cause of Death database of CDC Wide-Ranging Online Database for Epidemiological Research (1999-2022). We estimated the age-adjusted mortality rates (AAMRs) for ALD among adults 25 years and older. We calculated the average annual percentage change (AAPC) using the Joinpoint regression program.
There were 436,814 deaths related to ALD among US adults with rising mortality from 1999 (AAMR, 6.7) to 2022 (AAMR, 12.5) (AAPC, 2.7%). American Indian and Alaska Native (AI/AN) individuals had the highest mortality in 2022 (AAMR, 76.8), followed by Hispanic individuals (AAMR, 14.1). Mortality increases in non-Hispanic White (NHW) individuals (AAPC, 4.0%) surpassed that of non-Hispanic Black (NHB) individuals (AAPC, 0.4%). The increase in AAMR was more pronounced in rural areas (AAPC, 4.1%) than large metropolitan areas (AAPC, 2.0%). For NHW, AI/AN, and Hispanic individuals, AAMRs in rural areas had greater increases than in large metropolitan areas. AAMRs remained largely stable in large metropolitan (AAPC, - 0.6%) and rural areas for NHB individuals (AAPC, 0.1%).
There were significant and widening rural-urban disparities in ALD-related mortality among NHW, AI/AN, and Hispanic individuals. Mortality in NHB individuals remained largely stable. Targeted resources and efforts are essential to address the growing mortality burden in select populations.
在过去二十年中，与酒精性肝病（ALD）相关的死亡率一直在上升，尤其是在少数族裔和农村地区居民中。农村地区、种族和民族在死亡率差异方面的相互作用尚不清楚。
这项横断面研究从美国疾病控制与预防中心广泛在线流行病学研究数据库（1999 - 2022年）的死亡原因数据库中提取数据。我们估计了25岁及以上成年人中ALD的年龄调整死亡率（AAMR）。我们使用Joinpoint回归程序计算了平均年度百分比变化（AAPC）。
在美国成年人中，有436,814例死亡与ALD相关，死亡率从1999年（AAMR，6.7）上升至2022年（AAMR，12.5）（AAPC，2.7%）。2022年，美国印第安人和阿拉斯加原住民（AI/AN）的死亡率最高（AAMR，76.8），其次是西班牙裔个体（AAMR，14.1）。非西班牙裔白人（NHW）个体的死亡率增长（AAPC，4.0%）超过了非西班牙裔黑人（NHB）个体（AAPC，0.4%）。农村地区AAMR的增长（AAPC，4.1%）比大城市地区（AAPC，2.0%）更为明显。对于NHW、AI/AN和西班牙裔个体，农村地区的AAMR增幅大于大城市地区。对于NHB个体，大城市地区（AAPC， - 0.6%）和农村地区的AAMR基本保持稳定（AAPC，0.1%）。
在NHW、AI/AN和西班牙裔个体中，与ALD相关的死亡率存在显著且不断扩大的城乡差异。NHB个体的死亡率基本保持稳定。针对性的资源和努力对于应对特定人群中不断增加的死亡负担至关重要。
