Introduction: Alcoholic liver disease (ALD) remains the most common type of chronic liver disease in the United States (US) and is a leading cause of morbidity and mortality. Our study aimed to evaluate mortality trends related to ALD in the United States between 1999 and 2020 and identify subpopulations that are disproportionately affected. Methods: We conducted cross-sectional analyses of all ALD-related mortality in the US using death certificate information from the National Vital Statistics System. Age-adjusted mortality rates (AAMR) per 100,000 population were compared among age, sex, racial/ethnic, and geographic subpopulations. Trends in mortality were examined using log-linear regression models to estimate average annual percentage change (AAPC). Results: The study identified 373,302 deaths related to ALD from 1999 to 2020. The AAMR increased from 4.34 (95% confidence interval [CI], 4.26 – 4.42) in 1999 to 7.86 (95% CI, 7.77 – 7.96) in 2020 with an AAPC of +2.7% (95% CI, 2.2 – 3.3, P < 0.001). Males (AAMR: 7.52 [95% CI, 7.49 – 7.55]) had a higher AAMR than females (AAMR: 2.88 [95% CI, 2.86 – 2.90]); however, AAPC was higher in females (AAPC: +4.0% [95% CI, 3.3 – 4.7]) compared to males (AAPC: +2.1% [95% CI, 1.6 – 2.7]). AAMR was highest in adults aged 35 to 64 years (AAMR: 9.95 [95% CI, 9.92 – 9.99]). AAPC was most prominent in individuals < 35 years (AAPC: +7.4% [95% CI, 5.3 – 9.6]). American Indian/Alaska Native (AAMR: 17.33 [95% CI, 17.03 – 17.63]) populations had the highest AAMR, followed by White (AAMR: 5.36 [95% CI, 5.34 – 5.37]), Black (AAMR: 3.64 [95% CI, 3.60 – 3.68]), and Asian/Pacific Islander (AAMR: 1.30 [95% CI, 1.26 – 1.33]) populations. Non-metropolitan (AAMR: 5.47 [95% CI, 5.42 – 5.51]) regions had a higher AAMR compared to metropolitan regions (AAMR: 5.03 [95% CI, 5.01 – 5.05]). Western (AAMR: 8.20 [95% CI, 8.15 – 8.24]) regions had the highest AAMR compared to the other United States census regions. Conclusion: The results of our study reveal a rise in ALD-related deaths from 1999 to 2020, with specific subpopulations in the US being affected at a higher rate. The subgroup analyses show a higher AAMR in men, adults aged 35 to 64 years old, Hispanic populations, and non-metropolitan regions. These findings highlight the pressing necessity for greater awareness and intervention to address the growing burden of ALD mortality in the US (Figure 1).Figure 1.: Mortality Trends Related to Alcoholic Liver Disease in the United States from 1999-2020.
Abstract Background Cardiac arrest (CA) is a leading cause of death in the United States (US). Social determinants of health may impact CA outcomes. We aimed to assess mortality trends, disparities, and the influence of the social vulnerability index (SVI) on CA outcomes in the young. Methods We conducted a cross‐sectional analysis of age‐adjusted mortality rates (AAMRs) related to CA in the United States from the Years 1999 to 2020 in individuals aged 35 years and younger. Data were obtained from death certificates and analyzed using log‐linear regression models. We examined disparities in mortality rates based on demographic variables. We also explored the impact of the SVI on CA mortality. Results A total of 4792 CA deaths in the young were identified. Overall AAMR decreased from 0.20 in 1999 to 0.14 in 2020 with an average annual percentage change of −1.3% ( p = .001). Black ( AAMR : 0.30) and male populations ( AAMR : 0.14) had higher AAMR compared with White ( AAMR : 0.11) and female ( AAMR : 0.11) populations, respectively. Nonmetropolitan ( AAMR : 0.29) and Southern ( AAMR : 0.26) regions were also impacted by higher AAMR compared with metropolitan ( AAMR : 0.11) and other US census regions, respectively. A higher SVI was associated with greater mortality risks related to CA ( risk ratio : 1.82 [95% CI, 1.77–1.87]). Conclusions Our analysis of CA in the young revealed disparities based on demographics, with a decline in AAMR from 1999 to 2020. There is a correlation between a higher SVI and increased CA mortality risk, highlighting the importance of targeted interventions to address these disparities effectively.
Peripartum cardiomyopathy (PPCM) outcomes have been previously linked to demographic and social factors. The social vulnerability index (SVI) is a measure of social vulnerability in the United States. We explored PPCM disparities and the impact of SVI on PPCM mortality.
Social vulnerability index (SVI) plays a pivotal role in the outcomes of cardiovascular diseases and prevalence of alcohol use. We evaluated the impact of the SVI on alcoholic cardiomyopathy (ACM) mortality.Mortality data from 1999 to 2020 and the SVI were obtained from CDC databases. Demographics such as age, sex, race/ethnicity, and geographic residence were obtained from death certificates. The SVI was divided into quartiles, with the fourth quartile (Q4) representing the highest vulnerability. Age-adjusted mortality rates across SVI quartiles were compared, and excess deaths due to higher SVI were calculated. Risk ratios were calculated using univariable Poisson regression.A total of 2779 deaths were seen in Q4 compared to 1672 deaths in Q1. Higher SVI accounted for 1107 excess-deaths in the US and 0.05 excess deaths per 100,000 person-years (RR: 1.38). Similar trends were seen for both male (RR: 1.43) and female (RR: 1.67) populations. Higher SVI accounted for 0.06 excess deaths per 100,000 person-years in Hispanic populations (RR: 2.50) and 0.06 excess deaths per 100,000 person-years in non-Hispanic populations (RR: 1.46).Counties with elevated SVI experienced higher ACM mortality rates. Recognizing the impact of SVI on ACM mortality can guide targeted interventions and public health strategies, emphasizing health equity and minimizing disparities.
Social vulnerability index (SVI) estimates the vulnerability of communities to disasters, encompassing 4 separate domains (socioeconomic, household composition and disability, minority status and language, and housing and transportation). The SVI has been linked with risk and outcomes of cardiovascular disease (CVD).
