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Mortality caused by chronic liver disease among American Indians and Alaska Natives in the United States, 1999-2009

TitleMortality caused by chronic liver disease among American Indians and Alaska Natives in the United States, 1999-2009
Publication TypeJournal Article
Year of Publication2014
AuthorsSuryaprasad, A, Byrd, KK, Redd, JT, Perdue, DG, Manos, MM, McMahon, BJ
JournalAm J Public HealthAm J Public Health
Volume104 Suppl 3
PaginationS350-8
Date PublishedJun
ISBN Number1541-0048 (Electronic)<br/>0090-0036 (Linking)
Accession Number24754616
KeywordsAdult, Age Distribution, Aged, Aged, 80 and Over, Alaska/epidemiology, Cause of Death, Chronic Disease, Death Certificates, European Continental Ancestry Group/statistics & numerical data, Female, Humans, Indians, North American/ statistics & numerical data, Inuits/ statistics & numerical data, Liver Diseases/ ethnology/ mortality, Male, Middle Aged, Sex Distribution, United States/epidemiology
AbstractOBJECTIVES: We compared chronic liver disease (CLD) mortality from 1999 to 2009 between American Indians and Alaska Natives (AI/ANs) and Whites in the United States after improving CLD case ascertainment and AI/AN race classification. METHODS: We defined CLD deaths and causes by comprehensive death certificate-based diagnostic codes. To improve race classification, we linked US mortality data to Indian Health Service enrollment records, and we restricted analyses to Contract Health Service Delivery Areas and to non-Hispanic populations. We calculated CLD death rates (per 100,000) in 6 geographic regions. We then described trends using linear modeling. RESULTS: CLD mortality increased from 1999 to 2009 in AI/AN persons and Whites. Overall, the CLD death rate ratio (RR) of AI/AN individuals to Whites was 3.7 and varied by region. The RR was higher in women (4.7), those aged 25 to 44 years (7.4), persons residing in the Northern Plains (6.4), and persons dying of cirrhosis (4.0) versus hepatocellular carcinoma (2.5), particularly those aged 25 to 44 years (7.7). CONCLUSIONS: AI/AN persons had greater CLD mortality, particularly from premature cirrhosis, than Whites, with variable mortality by region. Comprehensive prevention and care strategies are urgently needed to stem the CLD epidemic among AI/AN individuals.
Ethno Med: