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1999年至2020年美国成年人中肝纤维化和肝硬化相关死亡率的趋势及人口统计学特征：疾病控制与预防中心Wonder分析

Trends and Demographics of Liver Fibrosis and Cirrhosis-Related Mortality Among Adults Living in the United States From 1999 to 2020: A CDC Wonder Analysis.

作者信息

Shahzad Muhammad, Bokhari Syeda Sundus Shah, Rabia Fnu, Khan Amna Zaman, Ali Muhammad Abdullah, Hashim Ali, Shahzad Farah, Tariq Maryam, Barkat-Ullah Zarhaish, Rasheed Malaika, Niazi Muhammad Uzair Khan, Hassan Ali, Khan Asfand Yar, Awan Taha Mazhar, Waqas Saad Ahmed, Ahmed Raheel

机构信息

Foundation University Medical College Islamabad Pakistan.

Ayub Medical College Abbottabad Pakistan.

出版信息

JGH Open. 2025 Sep 26;9(10):e70247. doi: 10.1002/jgh3.70247. eCollection 2025 Oct.

DOI:10.1002/jgh3.70247
PMID:41019032
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12474855/
Abstract

INTRODUCTION

Liver cirrhosis, the fifth leading cause of adult mortality, involves progressive, irreversible liver fibrosis and loss of function. Its rising prevalence necessitates studying trends, identifying high-risk groups, and enhancing preventive strategies. This study aims to assess temporal trends and demographic disparities in liver fibrosis and cirrhosis-related mortality in the United States from 1999 to 2020.

METHODS

Death certificates from the CDC WONDER(Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database for 1999-2020 were analyzed for liver fibrosis and cirrhosis-associated mortality in adults > 25 years. AAMRs per 100 000 were stratified by year, sex, race/ethnicity, and region. Joinpoint Regression (v5.3.0.0) calculated annual percent change (APC) and average APC (AAPC), identifying significant trends ( < 0.05, two-tailed test).

RESULTS

From 1999 to 2020, 787 375 liver cirrhosis-related deaths occurred in adults > 25. AAMR increased from 16.61 (1999) to 18.93 (2020). Men had a higher AAMR (21.51; 95% CI: 21.44 to 21.57) than women (11.73; 95% CI: 11.68 to 11.77). AAMRs were highest in Non-Hispanic (NH) American Indian (26.42; 95% CI: 25.91 to 26.93) followed by Hispanics (24.93; 95% CI: 24.77 to 25.09), NH White (16.71; 95% CI: 16.67 to 16.75), NH Black (15.13; 95% CI: 15.02 to 15.24), and NH Asian/Pacific Islander (9.29; 95% CI: 9.15 to 9.42). By region, the South had the highest AAMR (18.87; 95% CI: 18.8 to 18.93), followed by the West (15.75; 95% CI: 15.67 to 15.82), Midwest (14.55; 95% CI: 14.47 to 14.62), and Northeast (14.17; 95% CI: 14.1 to 14.25). Micropolitan (Nonmetro) areas had the highest AAMR (17.62; 95% CI: 17.49 to 17.74), while Large Fringe Metro Areas had the lowest AAMR (14.2; 95% CI: 14.13 to 14.27). Texas reported the highest AAMR (25.7); Nebraska reported the lowest (9.4).

DISCUSSION

Liver cirrhosis-related mortality has risen since 1999, especially among Hispanic adults, men, and those in Southern or nonmetropolitan regions. Targeted prevention is needed to reduce mortality in these high-risk groups.

摘要

引言

肝硬化是成人死亡的第五大主要原因，涉及进行性、不可逆的肝纤维化和功能丧失。其患病率不断上升，因此有必要研究趋势、确定高危人群并加强预防策略。本研究旨在评估1999年至2020年美国肝纤维化和肝硬化相关死亡率的时间趋势及人口统计学差异。

方法

分析了疾病控制与预防中心（CDC）的WONDER（疾病控制与预防中心广泛在线流行病学研究数据）数据库中1999 - 2020年25岁以上成年人的死亡证明，以获取肝纤维化和肝硬化相关死亡率。每10万人的年龄调整死亡率（AAMR）按年份、性别、种族/族裔和地区进行分层。连接点回归（v5.3.0.0）计算年度百分比变化（APC）和平均APC（AAPC），以确定显著趋势（p < 0.05，双侧检验）。

结果

1999年至2020年，25岁以上成年人中有787375例肝硬化相关死亡。AAMR从1999年的16.61上升至2020年的18.93。男性的AAMR（21.51；95%置信区间：21.44至21.57）高于女性（11.73；95%置信区间：11.68至11.77）。AAMR在非西班牙裔（NH）美国印第安人中最高（26.42；95%置信区间：25.91至26.93），其次是西班牙裔（24.93；95%置信区间：24.77至25.09）、NH白人（16.71；95%置信区间：16.67至16.75）、NH黑人（15.13；95%置信区间：15.02至15.24）以及NH亚太岛民（9.29；95%置信区间：9.15至9.42）。按地区划分，南部的AAMR最高（18.87；95%置信区间：18.8至18.93），其次是西部（15.75；95%置信区间：15.67至15.82）、中西部（14.55；95%置信区间：14.47至14.62）和东北部（14.17；95%置信区间：14.1至14.25）。微型都市（非都市）地区的AAMR最高（17.62；95%置信区间：17.49至17.74），而大型边缘都市地区的AAMR最低（14.2；95%置信区间：14.13至14.27）。得克萨斯州报告的AAMR最高（25.7）；内布拉斯加州报告的最低（9.4）。

讨论

自1999年以来，肝硬化相关死亡率有所上升，尤其是在西班牙裔成年人、男性以及南部或非都市地区的人群中。需要有针对性的预防措施来降低这些高危人群的死亡率。

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