Zafar Yousaf, Dodd Isaac M E, Iqbal Arsalan Zafar, Manzoor Laila, Iqbal Naveed Zafar, Dodd Kristen D, Petrasek Jan
University of Mississippi Medical Center, Jackson, MS, USA.
Department of Medicine, Division of Hospital Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA.
BMC Public Health. 2025 Jun 2;25(1):2046. doi: 10.1186/s12889-025-22895-x.
A leading cause of death among non-Hispanic American Indians or Alaskan Natives (AI/ANs), apart from cardiovascular disease and unintentional injuries, is chronic liver disease (CLD). This study analyzed recent trends in AI/AN ALD mortality, given their increased incidence of alcoholic liver disease (ALD) and high burden of CLD.
This cross-sectional study used data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). Geographic, age and sex-based temporal mortality trends of ALD deaths were analyzed among the AI/AN population in the US from 1999 to 2020. Joinpoint regression analyses determined trends in ALD crude and age-adjusted mortality rates, identifying the annual percent change (APC) in each subgroup.
In 1999-2020, the overall age-adjusted mortality rate (AAMR) among AI/ANs increased significantly from 27.2/100,000 to 88.4/100,000. Although men had a higher mortality rate overall, women had a higher increase in APC (2003-2008 APC was 17.7 [95% Cl: 9.9-26.0] and 2018-2020 APC was 25.3 [95% Cl: 11.4-40.9]) compared to men (1999-2020 APC was 5.8 [95% Cl 4.8-6.8]). All age groups studied witnessed an increase in AAMR. However, the age group 45-64 had the highest mortality overall in the preceding 2 decades. Non-metropolitan geographic regions had the highest mortality rate (2018-2020 APC of 25.5 [95% Cl: 5.0-50.0]) compared to medium/small or large metro areas. Western and Midwestern US Census regions had the highest mortality rates.
Male sex, age 44-65, and rural dwelling was associated with a greater ALD AAMR in AI/AN populations. Social changes due to the Covid-19 pandemic may have led to increased ALD mortality. Discerning the underlying causality of these associations and examining the impact of the social determinants of health, may represent important opportunities to enhance care for AI/ANs as a vulnerable minority population.
在美国非西班牙裔印第安人或阿拉斯加原住民（AI/ANs）中，除心血管疾病和意外伤害外，慢性肝病（CLD）是主要死因之一。鉴于AI/ANs酒精性肝病（ALD）发病率上升以及CLD负担沉重，本研究分析了AI/ANs中ALD死亡率的近期趋势。
这项横断面研究使用了美国疾病控制与预防中心的广泛流行病学研究在线数据（CDC WONDER）。分析了1999年至2020年美国AI/ANs人群中基于地理、年龄和性别的ALD死亡时间趋势。Joinpoint回归分析确定了ALD粗死亡率和年龄调整死亡率的趋势，确定了每个亚组的年度百分比变化（APC）。
在1999 - 2020年期间，AI/ANs的总体年龄调整死亡率（AAMR）从27.2/10万显著上升至88.4/10万。尽管总体上男性死亡率较高，但与男性相比，女性的APC上升幅度更大（2003 - 2008年APC为17.7[95%CI：9.9 - 26.0]，2018 - 2020年APC为25.3[95%CI：11.4 - 40.9]），而男性为5.8[95%CI 4.8 - 6.8]）。所有研究年龄组的AAMR均有所上升。然而，45 - 64岁年龄组在过去20年中总体死亡率最高。与中小城市或大城市地区相比，非大城市地理区域的死亡率最高（2018 - 2020年APC为25.5[95%CI：5.0 - 50.0]）。美国西部和中西部人口普查区域的死亡率最高。
在AI/ANs人群中，男性、44 - 65岁年龄以及农村居住与更高的ALD AAMR相关。新冠疫情导致的社会变化可能导致ALD死亡率上升。识别这些关联的潜在因果关系并研究健康的社会决定因素的影响，可能是加强对作为弱势群体的AI/ANs护理的重要机会。
