Shim Y K, Perper J A, Kuller L H
Department of Epidemiology, University of Pittsburgh, PA 15261.
Am J Epidemiol. 1993 Oct 1;138(7):531-43. doi: 10.1093/oxfordjournals.aje.a116887.
From 1973 to 1985, the age-adjusted death rate from liver cirrhosis (International Classification of Diseases, Ninth Revision, code 571) dropped by 62.7% among adults aged 25-54 years in Allegheny County, Pennsylvania. The authors investigated factors associated with this decline by verifying causes of death on death certificates from medical records, coroner's reports, and autopsy reports. Although death rates from cirrhosis were slightly underestimated from death certificates, the underestimation did not alter the declining mortality trend. This decline in rates was significant after adjustment of the age, sex, and race effect using statistical modeling. No significant variability in the time trends was noted between sexes, races, and age groups. Neither did the trends in alcohol-related and "unspecified" cirrhosis differ. However, the trends varied significantly between the cirrhosis deaths certified by the coroner and by noncoroner physicians. From 1973-1975 to 1976-1978, the rate initially dropped by 51% among the coroner cases, whereas it dropped by only 9% among the noncoroner cases. By the period 1982-1985, the death rates of both coroner and noncoroner cases declined to approximately 50% of their 1973-1975 rates. These results suggest that the decline during the years 1973-1985 was real and that the trend was initiated by the pronounced decline during the early years in the coroner-certified cirrhosis deaths.
1973年至1985年期间，宾夕法尼亚州阿勒格尼县25至54岁成年人中，年龄调整后的肝硬化死亡率（国际疾病分类第九版，编码571）下降了62.7%。作者通过核对病历、验尸官报告和尸检报告中的死亡证明来调查与这一下降相关的因素。尽管死亡证明上的肝硬化死亡率略有低估，但这种低估并未改变死亡率下降的趋势。使用统计模型对年龄、性别和种族效应进行调整后，死亡率的下降具有显著性。在性别、种族和年龄组之间，未观察到时间趋势的显著差异。酒精相关肝硬化和“未明确说明”的肝硬化趋势也没有差异。然而，验尸官认证的肝硬化死亡和非验尸官医生认证的肝硬化死亡趋势存在显著差异。从1973 - 1975年到1976 - 1978年，验尸官认证的病例中死亡率最初下降了51%，而非验尸官认证的病例中仅下降了9%。到1982 - 1985年期间，验尸官认证和非验尸官认证病例的死亡率均降至1973 - 1975年死亡率的约50%。这些结果表明，1973年至1985年期间的下降是真实的，且这一趋势是由早期验尸官认证的肝硬化死亡人数的显著下降引发的。
