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Home » Publications » Surveillance Reports » Surveillance Report #93

National Institute on Alcohol Abuse and Alcoholism
Division of Epidemiology and Prevention Research
Alcohol Epidemiologic Data System

SURVEILLANCE REPORT #93

LIVER CIRRHOSIS MORTALITY IN THE UNITED STATES, 1970–2009

Young-Hee Yoon, Ph.D.
Hsiao-ye Yi, Ph.D.

CSR, Incorporated1
Suite 1000
2107 Wilson Boulevard
Arlington, VA 22201

August 2012


U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health

1 CSR, Incorporated, operates the Alcohol Epidemiologic Data System (AEDS) under Contract No. HHSN267200800023 for the Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA). Dr. Rosalind A. Breslow serves as NIAAA Project Officer on the contract.

HIGHLIGHTS

This surveillance report, prepared biennially by the Alcohol Epidemiologic Data System (AEDS), National Institute on Alcohol Abuse and Alcoholism (NIAAA), presents trends in liver cirrhosis mortality in the United States. Data on the underlying cause of death were compiled from public use data tapes published annually by the National Center for Health Statistics (NCHS). Population data provided by the U.S. Census Bureau are used as denominators to calculate mortality rates. In this issue, the 2000s population data used previously in this report were replaced with the reestimated intercensal population data that bridge the 2000 and 2010 censuses. This resulted in minor changes in the calculated liver cirrhosis mortality rates for some subpopulation groups for the 2000s compared with prior issues of this report (see page 3 for details).

Overall cirrhosis mortality in the United States increased steadily following the end of Prohibition in 1933 until 1973, when the age-adjusted death rate peaked at 18.1 deaths per 100,000 population. Cirrhosis mortality then began an almost steady decline that has continued throughout the last four decades. The following are highlights of liver cirrhosis mortality trends from the early 1970s through 2009, the most recent year for which data are available.

Cirrhosis Mortality in 2009

  • In 2009 liver cirrhosis was the 12th leading cause of death in the United States, with a total of 31,522 deaths—664 more than in 2008. The crude death rate from all cirrhosis and alcohol-related cirrhosis increased by 2.0 percent from 2008 to 2009.

  • Among all cirrhosis deaths in 2009, 48.2 percent were alcohol-related. The proportion of alcohol-related cirrhosis was highest (70.6 percent) among decedents aged 35 to 44.

  • The age-adjusted death rate from all cirrhosis for Hispanic White males was 1.7 times the rate for non-Hispanic White males and 2.1 times the rate for non-Hispanic Black males. The rate for Hispanic White females was 1.5 times the rate for non-Hispanic White females and 2.2 times the rate for non-Hispanic Black females.

  • Wide variations existed across Hispanic subgroups; the 5-year annual average of age-adjusted death rates from all cirrhosis was highest for Mexicans and Puerto Ricans and lowest for Cubans, among both males and females.

Cirrhosis Mortality Trends

  • While the age-adjusted all-cause mortality rate declined by 39.4 percent from 1970 to 2009, the age-adjusted death rate from all liver cirrhosis declined for the same period by 47.2 percent, from 17.8 to 9.4 deaths per 100,000 population. Rates for White males, Black males, White females, and Black females declined by 42.7, 73.6, 37.4, and 77.5 percent, respectively.

  • The age-adjusted death rate from all liver cirrhosis for males was consistently twice or more the rate for females, regardless of race.

  • The age-adjusted death rate from alcohol-related liver cirrhosis declined by 28.6 percent, from 6.3 deaths per 100,000 population in 1970 to 4.5 deaths per 100,000 population in 2009. Rates for White males, Black males, White females, and Black females declined by 15.3, 73.5, 16.1, and 77.2 percent, respectively.

Healthy People 2010 Objectives

  • One of the Healthy People 2010 objectives is to reduce liver cirrhosis mortality to no more than 3.2 deaths per 100,000 population. Although the 2010 mortality data are not available yet, it is safe to say that liver cirrhosis mortality will not experience a large enough decline from its 2009 age-adjusted rate of 9.4 to meet that goal by 2010.


INTRODUCTION

This surveillance report on liver cirrhosis is one of a series of four reports published annually or biennially to monitor trends in alcohol consumption and alcohol-related morbidity and mortality in the United States. These surveillance reports are prepared by the Alcohol Epidemiologic Data System (AEDS), Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), and are intended to be useful to researchers, policymakers, and other professionals interested in alcohol abuse and its long-term effects. The data also are essential in assessing progress toward meeting the Nation’s health promotion and disease prevention objective of reducing liver cirrhosis mortality, as stated in Healthy People 2010 (Department of Health and Human Services [HHS] 2000).

Cirrhosis of the liver is an outcome with a variety of causes, including alcohol consumption, exposure to various drugs and toxic chemicals, viral hepatitis, and other viral and infectious diseases (Dufour et al. 1993). It has been well established that alcohol consumption is a major contributor to deaths from cirrhosis and the related condition of alcoholic hepatitis (Mann et al. 2003).

The level and duration of alcohol consumption are important determinants in the development of liver pathology. As the primary site for detoxification of alcohol by oxidation of its metabolites, the liver can undergo three pathologies: fatty liver, alcoholic hepatitis, and cirrhosis. The prognosis for patients with cirrhosis is highly unpredictable. Although some patients can benefit from a liver transplant, at present, no method exists for repairing liver damage associated with cirrhosis. However, the consequences of this disease can be treated, and life can be prolonged, if patients with cirrhosis resulting from alcohol consumption abstain from further alcohol use. Thus, early detection and prevention of further damage are important in prolonging life.

The coding scheme used in the United States to classify cause of death is the International Classification of Diseases (ICD), a statistical classification of disease and injury widely used by countries supporting mortality reporting systems. ICD codes classify the cause of death from cirrhosis as either related to alcohol or not related to alcohol. Because of the stigma associated with excessive alcohol use, physicians and other officials who certify causes of death may not identify alcohol in the case of a death from cirrhosis in an effort to protect family members. From 1970 to 2009, the proportion of all cirrhosis deaths coded as alcohol-related ranged from 36 to 48 percent (depending on year), even though some researchers believe alcohol might have contributed to a substantially higher proportion of all deaths from cirrhosis (Haberman and Weinbaum 1990; Powell and Klatskin 1968). For this reason, this surveillance report examines all cirrhosis deaths, as well as those that are explicitly coded as alcohol-related.


DATA AND MEASURES

Data Sources

Death counts and rates in this report are based on a single underlying cause for each death, defined as “the disease or injury which initiated the train of morbid events leading directly or indirectly to death or circumstances of the accident or violence which produced the fatal injury” (NCHS 1982). This approach is consistent with other mortality statistics reported by NCHS.

Cirrhosis death records for 1970–2009 were extracted from public use mortality data files produced by NCHS. With the exception of data files for 1972, these files contain individual records for each death occurring in the United States, and in 1972 the files contained a 50-percent sample of all U.S. deaths. The deaths counted in this report are for U.S. residents only. Deaths of foreign residents in the United States are not counted.

Prior to the 2010 issue of this report, historical cirrhosis mortality rates (presented in Figure 1 and Table 1) for years 1910–1969 were calculated based on age-specific death rates from an NIAAA data reference manual on cirrhosis mortality (NIAAA 1985). However, the age-specific death rates for ages younger than 25 were indirectly derived due to the lack of data for the young age segment in that publication. In the 2010 issue, the historical data were recalculated based on original historical government documents that NCHS recently made available on the Internet. For years 1920–1969, the data sources included the annual reports of the Mortality Statistics (Bureau of the Census 1922–1938) and Vital Statistics in the United States (Bureau of the Census 1939–1946; National Office of Vital Statistics 1947–1951, 1953–1960; National Center for Health Statistics, 1961–1974). For years 1910–1919, the data sources included the National Office of Vital Statistics special report (1956) and intercensal resident population estimates in death registration States developed by the Bureau of the Census and presented in Linder and Grove (1943). The recalculation did not result in any substantial changes in the historical trends. However, it filled in a few missing dots in the trend lines for the early years, and made slight modifications in the historical cirrhosis death rates. Note that all historical mortality statistics were based on numbers obtained through State death registration offices. Before 1933 not all States collected death registration information. The changing number of death registration States impedes the process of obtaining comparable mortality data for the United States prior to 1933.

Population data from various estimates provided by the U.S. Census Bureau were used as denominators for calculating mortality rates in this report. For years 2000 through 2009, population data came from the newly released bridged race intercensal estimates developed for NCHS by the U.S. Census Bureau (NCHS 2011). These reestimates bridge the 2000 and 2010 censuses. Following its past practice, AEDS used the reestimates to replace population data for years 2000 through 2007 used in the previous issues of this report. This resulted in almost no changes in the overall age-adjusted mortality rates for those years as slight, but opposite changes occurred in the rates for some demographic subgroups. For instance, compared with numbers published in the previous issues, the revised age-specific cirrhosis death rates are slightly lower for the 55–84 age groups, but slightly higher for the 85 or older age group. Similarly, the revised age-adjusted mortality rates are slightly higher than the previous numbers for Whites but slight lower for Blacks. However, rates for some small population subgroups, such as Black Hispanics, were largely affected by the use of the population reestimates. In any case, rates calculated for Black Hispanics should be considered unreliable because of the small size of this population subgroup.

Population data for years 1990 through 1999 came from bridged-race intercensal resident population estimates developed for NCHS by the U.S. Census Bureau (NCHS 2003). Population data for 1970–1989 came from estimates developed for the National Cancer Institute (NCI) by the U.S. Census Bureau (NCI 2002). Population data for 1910–1969 came from intercensal resident population estimates developed by the U.S. Census Bureau (Lindner and Grove 1943; Grove and Hetzel 1968; Bureau of the Census 1965, 1968, 1969, 1970).

Hispanic subgroup population data were taken from estimates based on the Current Population Survey (CPS) prepared by the U.S. Census Bureau for NCHS (Arias et al. 2003; Hoyert et al. 2006; Kochanek et al. 2004; Miniño et al. 2002; Miniño et al. 2007; Xu et al. 2010; Kochanek et al. 2011). The CPS population estimates were adjusted to resident Hispanic population control totals (i.e., the year 2000-based population estimates for the respective subpopulations in the United States for July 1 of each year).

Definitions and Subclassifications of Liver Cirrhosis

During the period for which mortality statistics are shown in this report, cause of death was classified according to nine different revisions of the ICD. The ICD has been revised periodically to reflect progress in medical knowledge, with later revisions generally providing greater specificity of coding.

The eighth (NCHS 1968), ninth (World Health Organization [WHO] 1978), and tenth (WHO 1992) revisions of the ICD (ICD-8, ICD-9, and ICD-10, implemented in 1968, 1979, and 1999, respectively) provide for coding categories of cirrhosis with and without mention of alcohol. ICD-9 uses different categories for cirrhosis than did ICDA-8. ICD-10 uses twice as many categories for cirrhosis as did ICD-9. To examine trends for comparable diseases from 1970–2009, ICD-9 and ICD-10 categories must be matched and recoded to those consistent with ICDA-8 categories. The relevant crosswalk of the three ICD revisions, developed by AEDS staff in collaboration with NIAAA’s former Division of Biometry and Epidemiology (DBE), is shown in the table on the next page. As can be seen under ICD-10, AEDS includes portal hypertension (ICD code K76.6) and change of fatty liver not elsewhere classified (n.e.c.) (ICD code K76.0) among cirrhosis categories. Because NCHS counts only ICD codes K70, K73, and K74 as liver cirrhosis, AEDS numbers are slightly larger than those reported by NCHS.

With the introduction of ICD-10 for 1999 data came changes in rules for selecting the underlying cause of death and new categories. These new rules and categories may contribute to observed changes in the number of deaths from liver cirrhosis. Anderson et al. (2001) conducted a comparability study which estimated that the use of ICD-10 would classify an additional 3.67 percent of deaths as due to cirrhosis when compared with ICD-9. Readers should keep this in mind when examining trends involving data from 1999 and later years. In addition, NCHS implemented coding changes in data for 2007, which resulted in more deaths being assigned to alcoholic liver disease (ICD-10 code K70). Therefore, the unusually big increase in cirrhosis deaths observed from 2006 to 2007 may be largely due to the coding changes (Xu et al. 2010).

.

Crosswalk of ICD-10 codes to ICD-9 codes and ICDA-8 codes
ICD-10 ICD-9 ICDA-8
K70.0 Alcoholic fatty liver 571.0 Alcoholic fatty liver 571.0 Alcohol-related liver cirrhosis
K70.1 Alcoholic hepatitis 571.1 Acute alcoholic hepatitis
K70.2 Alcoholic fibrosis and sclerosis of liver
K70.3 Alcoholic cirrhosis of liver
571.2 Alcoholic cirrhosis of liver
K70.9 Alcoholic liver disease, unspecified 571.3 Alcoholic liver damage, unspecified
K70.4 Alcoholic hepatic failure1

303 Alcohol dependence syndrome
plus
572.8 chronic hepatic failure

K73.0 Chronic persistent hepatitis, not elsewhere classified (n.e.c.)
K73.1 Chronic lobular hepatitis, n.e.c.
K73.2 Chronic active hepatitis, n.e.c.
K73.8 Other chronic hepatitis, n.e.c.
K73.9 Chronic hepatitis, unspecified
571.4 Chronic hepatitis 571.8 Specified liver cirrhosis without mention of alcohol
K74.3 Primary biliary cirrhosis
K74.4 Secondary biliary cirrhosis
K74.5 Biliary cirrhosis, unspecified
571.6 Biliary cirrhosis
K76.0 Fatty (change of) liver, n.e.c.2 571.8 Other chronic nonalcoholic liver disease
K76.6 Portal hypertension2 572.3 Portal hypertension
K74.0 Hepatic fibrosis
K74.2 Hepatic fibrosis with hepatic sclerosis
K74.6 Other and unspecified cirrhosis of liver
571.5 Cirrhosis of the liver without mention of alcohol 571.9 Unspecified liver cirrhosis without mention of alcohol
K74.1 Hepatic sclerosis 571.9 Unspecified liver cirrhosis without mention of alcohol

1 A new title in ICD-10 that requires the coexistence of two ICD-9 codes.
2 Not defined as liver cirrhosis by NCHS.

Race or Ethnicity of Decedent

Data are presented in this report by White and Black race categories, with other races such as American Indian/Alaska Native and Asian/ Pacific Islander included in the “all races” category but not shown separately. Beginning in 2003, multiple race reporting was implemented in 7 States (California, Idaho, Montana, New York, Hawaii, Maine, and Wisconsin), while the remaining 43 States and the District of Columbia allowed only a single race to be reported. To make the data uniform and comparable, NCHS “bridged” reported multiple race to single race. In this effort, multiracial decedents were imputed with a single race according to the combination of races, Hispanic origin, sex, and age indicated on their death certificates. The imputation procedure is described in detail at: http://www.cdc.gov/nchs/data/dvs/Multiple_race_docu_5-10-04.pdf.

Vital statistics data also provide information on the ethnicity of decedents (i.e., Mexican, Puerto Rican, Cuban, Central or South American, other or unknown Hispanic, or non-Hispanic). In this report, trend data by Hispanic origin were presented for the years 1991 and later because, prior to 1991, substantial proportions of decedents were missing ethnic identification, and Hispanic origin measures were not usable. From 1991 through 2009, the percentage of cirrhosis deaths with Hispanic origin unknown was less than 2 percent for both Black and White decedents. In 2009, only 0.3 percent of cirrhosis decedents had an “unknown” classification for Hispanic origin. The tables and figures showing data based on Hispanic origin excluded decedents for whom Hispanic origin could not be determined. Readers are cautioned that rates calculated for Black Hispanics are unreliable because of the small number of cirrhosis deaths in this population subgroup.

After a continuous, rapid population growth over the past few decades, Hispanics became the largest minority group in the United States in 2003. While Hispanics often are considered one ethnic group, they are well-known for heterogeneity by country of origin in terms of socioeconomic status and drinking patterns, which may well affect cirrhosis mortality. To provide information on Hispanic subgroup differences, beginning with the 2007 issue, this report presents additional data on cirrhosis death rates for four major Hispanic subgroups, namely Mexicans, Puerto Ricans, Cubans, and Other Hispanics.


METHODS

Statements of disease frequency, expressed as the number of deaths due to liver cirrhosis, have little epidemiologic usefulness because such information permits neither comparisons of mortality among various population subgroups nor the description of trends over time. For epidemiologic purposes, death rates are used to compare the frequency of death from a disease or condition. The following measures of disease frequency are used in this report to assess trends in liver cirrhosis mortality:

  • Unadjusted (or crude) death rates— These are summary measures calculated by dividing the total number of deaths due to cirrhosis (or subcategories) in the population in a certain year by the total number of individuals in that population in that year (i.e., population at risk). Problems can arise when comparing crude rates between various years to assess any change in mortality over time because the populations at risk may differ with respect to an underlying characteristic such as age, race, or sex. For example, an older population tends to have a higher rate of death for a target disease than a younger population because death from disease is more common in an aging population. In this case, rates in different populations should be assessed by comparing age-specific rates or age-adjusted rates.

  • Age-specific death rates—These rates for any year refer to the number of deaths due to liver cirrhosis (or subcategories) in a defined age interval, divided by the total number of persons in that age interval. For a given age interval, examining age-specific rates for various years allows comparison of mortality rates among subgroups of the population that do not differ in their age distribution. Age-specific rates also provide a basis for detailed study of the variation of mortality rates among different age intervals in any single year.

  • Age-adjusted death rates—These are statistically constructed summary rates that account for differences in mortality regardless of any difference in the age distribution between populations. Age adjustment assumes that populations have the same age distribution and applies a standard age distribution to calculate age-adjusted rates for various populations. Therefore, when comparing age-adjusted rates of two populations, any differences between the rates can no longer be due to the difference in the age distribution between the two populations. Age adjustment is crucial for standardizing rates over many years because the U.S. population has grown progressively older in recent decades. Without age adjustment, any apparent increases in unadjusted mortality rates for cirrhosis (or any other disease) could be caused by the fact that older people are more likely to die from disease.

According to the requirement of the U.S. Department of Health and Human Services (1998), this report applies the year 2000 standard population in calculations of all age-adjusted death rates (replacing the 1940 standard population used in issues published before 2002).1

1 Standard population age distribution:

Number
Age group
1940
2000
0 to 4 years 80,061 18,986,520
5 to 14 years 170,355 39,976,619
15 to 24 years 181,677 38,076,743
25 to 34 years 162,066 37,233,437
35 to 44 years 139,237 44,659,185
45 to 54 years 117,811 37,030,152
55 to 64 years 80,294 23,961,506
65 to 74 years 48,426 18,135,514
75 to 84 years 17,303 12,314,793
85+ years 2,770 4,259,173
All ages 1,000,000 274,633,642

Source: Murphy (2000) for 1940 age standard: Miniño et al. (2007) for 2000 age standard.

Age-adjusted death rates presented in this report were computed by using 10-year age intervals of the enumerated population of the United States in 2000 as the standard population. Results from the age adjustment allow for meaningful comparison of similar rates over long periods of time or from different subpopulations. The basic procedure involves finding the expected number of deaths that would have existed if the age-specific rates for a particular year prevailed in a population whose age distribution was like that of the United States in 2000. This was accomplished by multiplying the specific rates for each age group by the population for the corresponding age group in the standard population. The age-adjusted mortality rate was then calculated by adding the expected deaths for each age group and dividing this sum by the total population taken as the standard.

Rates for Hispanic subgroups are based on 5-year annual moving averages in order to increase the reliability of these estimates. Because the population data for these groups were drawn from the Current Population Survey, readers are cautioned that the rates are subject to sampling variability in the denominator as well as random fluctuations in the numerator.


REFERENCES

Anderson, R.N.; Minino, A.M.; Hoyert, D.L.; and Rosenberg, H.M. Comparability of cause of death between ICD-9 and ICD-10: Preliminary estimates. National Vital Statistics Reports, Vol. 49, No. 2. Hyattsville, MD: NCHS, 2001.

Arias, E.; Anderson, R.N.; Kung, H.-C.; Murphy, S.L.; and Kochanek, K.D. Deaths: Final Data for 2001. National Vital Statistics Reports, Vol. 52, No. 3. Hyattsville, MD: NCHS, 2003.

Bureau of the Census. Mortality Statistics (Data for Years 1920–1936). Washington, DC: Department of Commerce, 1922–1938. (http://www.cdc.gov/nchs/products/vsus.htm)

Bureau of the Census. Vital Statistics of the United States (Data for Years 1937–1944). Washington, DC: Department of Commerce, 1939–1946. (http://www.cdc.gov/nchs/products/vsus.htm)

Bureau of the Census. Estimates of the Population of the United States, by Age, Color, and Sex: July 1, 1960 to 1965. Current Population Reports Series P-25, No. 321. Washington, DC: Department of Commerce, 1965.

Bureau of the Census. Estimates of the Population of the United States, by Age, Color, and Sex: July 1, 1964 to 1967. Current Population Reports Series P-25, No. 385. Washington, DC: Department of Commerce, 1968.

Bureau of the Census. Estimates of the Population of the United States, by Age, Color, and Sex: July 1, 1968. Current Population Reports Series P-25, No. 416. Washington, DC: Department of Commerce, 1969.

Bureau of the Census. Estimates of the Population of the United States, by Age, Color, and Sex: July 1, 1969. Current Population Reports Series P-25, No. 441. Washington, DC: Department of Commerce, 1970.

Department of Health and Human Services. HHS Policy for Changing the Population Standard for Age Adjusting Death Rates. Memorandum from the Secretary (http://aspe.hhs.gov/datacncl/ageadj.htm), Washington, DC: DHHS, August 26, 1998.

Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. Vol. II. Washington, DC: DHHS, November, 2000.

Dufour, M.C.; Stinson, F.S.; and Caces, M.F. Trends in cirrhosis morbidity and mortality: United States, 1979–1988. Seminars in Liver Disease 13(2):109–125, 1993.

Grove, R.D.; and Hetzel, A.M. Vital Statistics Rates in the United States, 1940–1960. Public Health Service Publication No. 1677. Washington, DC.: Department of Health, Education, and Welfare, Public Health Service, National Center for Health Statistics, 1968.

Haberman, P.W.; and Weinbaum, D.F. Liver cirrhosis with and without mention of alcohol as cause of death. British Journal of Addiction 85(2):217–222, 1990.

Hoyert D.L.; Heron, M.P.; Murphy, S.L.; and Kung, H.-C. Deaths: Final Data for 2003. National Vital Statistics Reports, Vol. 54, No. 13. Hyattsville, MD: NCHS, 2006.

Kochanek, K.D.; Murphy, S.L.; Anderson, R.N.; and Scott, C. Deaths: Final Data for 2002. National Vital Statistics Reports, Vol. 53, No. 5. Hyattsville, MD: NCHS, 2004.

Kochanek, K.D.; Xu, J.; Murphy, S.L.; Miniño, A.M.; and Kung, H.C. Deaths: Final Data for 2009. National Vital Statistics Reports, Vol. 60, No. 3. Hyattsville, MD: NCHS, 2011.

Linder, F.E.; and Grove, R.D. Vital Statistics Rates in the United States: 1900–1940. Washington, DC: Department of Commerce, Bureau of the Census, 1943.

Mann, R.E.; Smart, R.G.; and Govoni, R. The epidemiology of alcoholic liver disease. Alcohol Research & Health 27(3):209–219, 2003.

Miniño, A.M.; Arias, E.; Kochanek, K.D.; Murphy, S.L.; and Smith, B.L. Deaths: Final Data for 2000. National Vital Statistics Reports, Vol. 50, No. 15. Hyattsville, MD: NCHS, 2002.

Miniño, A.M.; Heron, M.P.; Murphy, S.L.; and Kochanek, K.D. Deaths: Final Data for 2004. National Vital Statistics Reports, Vol. 55, No. 19. Hyattsville, MD: NCHS, 2007.

Murphy, S.L. Deaths: Final Data for 1998. National Vital Statistics Reports, Vol. 48, No. 11. Hyattsville, MD: NCHS, 2000.

National Cancer Institute. U.S. Population Data (http://seer.cancer.gov/popdata/download.html), 2002.

National Center for Health Statistics. Vital Statistics of the United States (Data for Years 1959–1969). Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, 1961–1974. (http://www.cdc.gov/nchs/products/vsus.htm)

National Center for Health Statistics. Eighth Revision, International Classification of Diseases Adapted for Use in the United States. DHEW Pub. No. PHS 1693. Washington, DC: DHEW, 1968.

National Center for Health Statistics. Instructions for Classifying the Underlying Cause of Death, 1983. Hyattsville, MD: NCHS, September 1982.

National Center for Health Statistics. Bridged-race Intercensal estimates of the July 1, 1990–July 1, 1999, United States resident population by State, county, age group, sex, race, and Hispanic origin, prepared by the U.S. Census Bureau with support from National Cancer Institute (http://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm), April 15, 2003.

National Center for Health Statistics. Intercensal estimates of the resident population of the United States for July 1, 2000–July 1, 2009, by year, single-year of age, bridged race, Hispanic origin, and sex. Prepared under a collaborative arrangement with the U.S. Census Bureau (http://www.cdc.gov/nchs/nvss/bridged_race.htm), November 3, 2011.

National Institute on Alcohol Abuse and Alcoholism (Alcohol Epidemiologic Data System). Liver Cirrhosis Mortality in the United States [U.S. Alcohol Epidemiologic Data Reference Manual, Volume 2]. Rockville, MD: DHHS, PHS, September 1985.

National Office of Vital Statistics. Vital Statistics of the United States (Data for Years 1945–1949). Washington, DC: Federal Security Agency, United States Public Health Service, 1947–1951. (http://www.cdc.gov/nchs/products/vsus.htm)

National Office of Vital Statistics. Vital Statistics of the United States (Data for Years 1950–1958). Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, 1953–1960. (http://www.cdc.gov/nchs/products/vsus.htm)

National Office of Vital Statistics. Death Rates by Age, Race, and Sex United States, 1900–1953: Cirrhosis of Liver. Vital Statistics-Special Reports. Vol. 43, No. 24. Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, 1956.

Powell, W.J., and Klatskin, G. Duration of survival in patients with Laennec’s cirrhosis: Influence of alcohol withdrawal, and possible effects of recent changes in general management of the disease. American Journal of Medicine 44:406, 1968.

World Health Organization. International Classification of Diseases, 9th Revision. Geneva, Switzerland: WHO, 1978.

World Health Organization. International Classification of Diseases and Related Health Problems, Tenth Revision. Geneva, Switzerland: WHO, 1992.

Xu, J.Q.; Kochanek, K.D.; Murphy, S.L.; and Tejada-Vera, B. Deaths: Final data for 2007. National Vital Statistics Reports, Vol. 58, No. 19. Hyattsville, MD: NCHS, 2010.


List of Figures

Figure 1. Age-adjusted death rates of liver cirrhosis by sex (death registration States, 1910–1932, and United States, 1933–2009).

Figure 2. Age-adjusted death rates of liver cirrhosis by sex and race, United States, 1970–2009.

Figure 3. Age-specific death rates of liver cirrhosis, United States, 1970–2009.

Figure 4. Age-specific death rates of liver cirrhosis by race and sex, United States, 1970–2009.

Figure 5. Age-adjusted death rates of liver cirrhosis by sex, race, and Hispanic origin, United States, 1970–2009.

Figure 6. Age-adjusted death rates of liver cirrhosis reported with and without mention of alcohol, United States, 1970–2009.

Figure 7. Percent of all cirrhosis deaths coded as alcohol-related by age, United States, 1970–2009.

Figure 8. Age-adjusted death rates of alcohol-related liver cirrhosis by sex, race, and Hispanic origin, United States, 1970–2009.

Figure 9. Age-adjusted death rates of specified liver cirrhosis without mention of alcohol by sex, race, and Hispanic origin, United States, 1970–2009.

Figure 10. Age-adjusted death rates of unspecified liver cirrhosis without mention of alcohol by sex, race, and Hispanic origin, United States, 1970–2009.

Figure 11.Five-year annual average of age-adjusted death rates of liver cirrhosis with and without mention of alcohol by Hispanic subgroup and sex, United States, 2005–2009.

 

List of Tables

Table 1. Age-adjusted death rates from liver cirrhosis by sex (death registration States, 1910–1932, and United States, 1933–2009).

Table 2. Age-specific number of deaths, age-specific death rates, and age-adjusted death rates from all liver cirrhosis by race, Hispanic origin, and sex, United States, 1970–2009.

Table 3. Age-specific number of deaths, age-specific death rates, and age-adjusted death rates from liver cirrhosis with and without mention of alcohol, United States, 1970–2009.

Table 4. Age-adjusted death rates from liver cirrhosis with and without mention of alcohol by sex, race, and Hispanic origin, United States, 1970–2009.

Table 5. Age-specific number of deaths, 5-year annual moving average of age-specific death rates, and age-adjusted death rates from all liver cirrhosis by Hispanic subgroup and sex, United States, 2000–2009.

Table 6. Age-specific number of deaths, 5-year annual moving average of age-specific death rates, and age-adjusted death rates from liver cirrhosis with and without mention of alcohol by Hispanic subgroup and sex, United States, 2000–2009.



Figure 1. Age-adjusted death rates of liver cirrhosis by sex (death registration States, 1910–1932, and United States, 1933–2009).

figure 1
Data for figure 1 are presented in Table 1.

Figure 2. Age-adjusted death rates of liver cirrhosis by sex and race, United States, 1970–2009.

figure 2
Data for figure 2 are presented in Table 2.

 

Figure 3. Age-specific death rates of liver cirrhosis, United States, 1970–2009.

figure 3
Data for figure 3 are presented in Table 2.

Figure 4. Age-specific death rates of liver cirrhosis
by race and sex, United States, 1970–2009.
Note: Different age groups have different vertical scales
(i.e., rates vary substantially by age).
Figure 4. Age group 25 to 34 graph
Figure 4. Age group 35 to 44 graph Figure 4. Age group 45 to 54 graph
Figure 4. Age group 55 to 64 graph Figure 4. Age group 65 to 74 graph
Figure 4. Age group 75 to 84 graph Figure 4. Age group 85 and older graph

Data for figure 4 are presented in Table 2.

 

Figure 5. Age-adjusted death rates of liver cirrhosis by sex, race, and Hispanic origin, United States, 1970–2009.

figure 5
Data for figure 5 are presented in Table 2.

 

Figure 6. Age-adjusted death rates of liver cirrhosis reported with and without mention of alcohol, United States, 1970–2009.

figure 6
Data for figure 6 are presented in Table 3.

 

Figure 7. Percent of all cirrhosis deaths coded as alcohol-related by age, United States, 1970–2009.

figure 7
Data for figure 7 are presented on this page.

 

Figure 8. Age-adjusted death rates of alcohol-related liver cirrhosis by sex, race, and Hispanic origin, United States, 1970–2009.

figure 8
Data for figure 8 are presented in Table 4.

 

Figure 9. Age-adjusted death rates of specified liver cirrhosis without mention of alcohol by sex, race, and Hispanic origin, United States, 1970–2009.

figure 9
Data for figure 9 are presented in Table 4.

 

Figure 10. Age-adjusted death rates of unspecified liver cirrhosis without mention of alcohol by sex, race, and Hispanic origin, United States, 1970–2009.

figure 10
Data for figure 10 are presented in Table 4.

 

Figure 11. Five-year annual average of age-adjusted death rates of liver cirrhosis with and without mention of alcohol by Hispanic subgroup and sex, United States, 2005–2009.

figure 11
Data for figure 11 are presented in Table 6.


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