The burden of cirrhosis mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities.

IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Public Health Pub Date : 2024-08-01 Epub Date: 2024-07-14 DOI:10.1016/S2468-2667(24)00131-2
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Abstract

Background: Cirrhosis is responsible for substantial health and economic burden in the USA. Reducing this burden requires better understanding of how rates of cirrhosis mortality vary by race and ethnicity and by geographical location. This study describes rates and trends in cirrhosis mortality for five racial and ethnic populations in 3110 US counties from 2000 to 2019.

Methods: We estimated cirrhosis mortality rates by county, race and ethnicity, and year (2000-19) using previously validated small-area estimation methods, death registration data from the US National Vital Statistics System, and population data from the US National Center for Health Statistics. Five racial and ethnic populations were considered: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Cirrhosis mortality rate estimates were age-standardised using the age distribution from the 2010 US census as the standard. For each racial and ethnic population, estimates are presented for all counties with a mean annual population greater than 1000.

Findings: From 2000 to 2019, national-level age-standardised cirrhosis mortality rates decreased in the Asian (23·8% [95% uncertainty interval 19·6-27·8], from 9·4 deaths per 100 000 population [8·9-9·9] to 7·1 per 100 000 [6·8-7·5]), Black (22·8% [20·6-24·8], from 19·8 per 100 000 [19·4-20·3] to 15·3 per 100 000 [15·0-15·6]), and Latino (15·3% [13·3-17·3], from 26·3 per 100 000 [25·6-27·0] to 22·3 per 100 000 [21·8-22·8]) populations and increased in the AIAN (39·3% [32·3-46·4], from 45·6 per 100 000 [40·6-50·6] to 63·5 per 100 000 [57·2-70·2] in 2000 and 2019, respectively) and White (25·8% [24·2-27·3], from 14·7 deaths per 100 000 [14·6-14·9] to 18·5 per 100 000 [18·4-18·7]) populations. In all years, cirrhosis mortality rates were lowest among the Asian population, highest among the AIAN population, and higher in males than females for each racial and ethnic population. The degree of heterogeneity in county-level cirrhosis mortality rates varied by racial and ethnic population, with the narrowest IQR in the Asian population (median 8·0 deaths per 100 000, IQR 6·4-10·4) and the widest in the AIAN population (55·1, 30·3-78·8). Cirrhosis mortality increased over the study period in almost all counties for the White (2957 [96·9%] of 3051 counties) and AIAN (421 [88·8%] of 474) populations, but in a smaller proportion of counties for the Asian, Black, and Latino populations. For all racial and ethnic populations, cirrhosis mortality rates increased in more counties between 2000 and 2015 than between 2015 and 2019.

Interpretation: Cirrhosis mortality increased nationally and in many counties from 2000 to 2019. Although the magnitude of racial and ethnic disparities decreased in some places, disparities nonetheless persisted, and mortality remained high in many locations and communities. Our findings underscore the need to implement targeted and locally tailored programmes and policies to reduce the burden of cirrhosis at both the national and local level.

Funding: US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).

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2000-19 年美国按郡、种族和民族划分的肝硬化死亡率负担:健康差异系统分析》(The burden of cirrhosis mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities)。
背景:肝硬化在美国造成了巨大的健康和经济负担。要减轻这一负担,就必须更好地了解不同种族和族裔以及不同地理位置的肝硬化死亡率有何差异。本研究描述了 2000 年至 2019 年期间美国 3110 个县中五个种族和民族人群的肝硬化死亡率及其变化趋势:我们使用先前验证过的小区域估算方法、美国国家生命统计系统的死亡登记数据以及美国国家卫生统计中心的人口数据,按县、种族和族裔以及年份(2000-19 年)估算了肝硬化死亡率。我们考虑了五个种族和民族的人群:美国印第安人或阿拉斯加原住民 (AIAN)、亚洲人或太平洋岛民 (Asian)、黑人、拉丁裔或西班牙裔 (Latino) 以及白人。肝硬化死亡率估计值以 2010 年美国人口普查的年龄分布为标准进行了年龄标准化。对于每个种族和民族的人口,估算值针对年平均人口大于 1000 人的所有县:从 2000 年到 2019 年,亚裔(23-8% [95% 不确定区间 19-6-27-8],从每 10 万人 9-4 例死亡 [8-9-9-9] 降至每 10 万人 7-1 例死亡 [6-8-7-5])、黑人(22-8% [20-6-24-8],从每 10 万人 19-8 例死亡 [19-4-20-3] 降至每 10 万人 15-3 例死亡 [15-0-15-6])和拉丁裔(15-3% [13-3-17-3]、从每 10 万人 26-3 例[25-6-27-0]降至每 10 万人 22-3 例[21-8-22-8]),而在 2000 年和 2019 年,亚裔美国人(39-3% [32-3-46-4],分别从每 10 万人 45-6 例[40-6-50-6]增至每 10 万人 63-5 例[57-2-70-2])和白人(25-8% [24-2-27-3],从每 10 万人 14-7 例[14-6-14-9]增至每 10 万人 18-5 例[18-4-18-7])中,肝硬化死亡率有所上升。在所有年份中,亚裔人口的肝硬化死亡率最低,亚裔美国人的肝硬化死亡率最高,在每个种族和族裔人口中,男性的肝硬化死亡率均高于女性。县级肝硬化死亡率的异质性程度因种族和族裔人口而异,亚裔人口的 IQR 最窄(中位数为每 10 万人中有 8-0 例死亡,IQR 为 6-4-10-4),亚裔美国人的 IQR 最宽(55-1,30-3-78-8)。在研究期间,几乎所有县的白人(3051 个县中的 2957 个[96-9%])和亚裔美国人(474 个县中的 421 个[88-8%])的肝硬化死亡率都有所上升,但亚裔、黑人和拉丁裔人口的肝硬化死亡率上升的县比例较小。就所有种族和族裔人口而言,2000 年至 2015 年期间肝硬化死亡率上升的县比 2015 年至 2019 年期间上升的县要多:从 2000 年到 2019 年,全国和许多县的肝硬化死亡率都有所上升。虽然一些地方的种族和民族差异有所减少,但差异依然存在,许多地方和社区的死亡率仍然很高。我们的研究结果表明,有必要在国家和地方层面实施有针对性的、因地制宜的计划和政策,以减轻肝硬化的负担:美国国立卫生研究院(院内研究计划、国立少数民族健康和健康差异研究所、国立心肺血液研究所、院内研究计划、国立癌症研究所、国立老龄化研究所、国立关节炎、肌肉骨骼和皮肤病研究所、疾病预防办公室以及行为和社会科学研究办公室)。
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来源期刊
Lancet Public Health
Lancet Public Health Medicine-Public Health, Environmental and Occupational Health
CiteScore
55.60
自引率
0.80%
发文量
305
审稿时长
8 weeks
期刊介绍: The Lancet Public Health is committed to tackling the most pressing issues across all aspects of public health. We have a strong commitment to using science to improve health equity and social justice. In line with the values and vision of The Lancet, we take a broad and inclusive approach to public health and are interested in interdisciplinary research. We publish a range of content types that can advance public health policies and outcomes. These include Articles, Review, Comment, and Correspondence. Learn more about the types of papers we publish.
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