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National Institute on Alcohol Abuse and Alcoholism
Division of Epidemiology and Prevention Research
Alcohol Epidemiologic Data System
SURVEILLANCE REPORT #79
LIVER CIRRHOSIS MORTALITY
IN THE UNITED STATES, 1970–2004
Young-Hee Yoon, Ph.D.
Hsiao-ye Yi, Ph.D.
CSR, Incorporated1
Suite 1000
2107 Wilson Boulevard
Arlington, VA 22201
August 2007
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. N01AA32007 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 and oversaw the preparation of
this report.
HIGHLIGHTS
This surveillance report, published by the 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. For the first time, this report presents data for Hispanic subgroups.
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 through 2004, the most recent year for which data are available. The following are highlights of liver cirrhosis mortality trends from the early 1970s through 2004:
Cirrhosis Mortality in 2004
In 2004 liver cirrhosis was the 12th leading cause of death in the United States, with a total of 27,554 deaths, 531 less than in 2003.
The crude death rate from all cirrhosis declined by 3.1 percent from 2003 to 2004, whereas the rate from alcohol-related cirrhosis did not change.
Among all cirrhosis deaths in 2004, 47.5 percent were alcohol-related. The proportion of alcohol-related cirrhosis was highest (67.1 percent) among decedents aged 25 to 34.
The age-adjusted death rate from all cirrhosis for White Hispanic males was 1.7 times the rate for White non-Hispanic and Black non-Hispanic males. The rate for White Hispanic females was 1.6 times the rate for White non-Hispanic females and 1.8 times the rate for Black non-Hispanic females.
Wide variations existed across Hispanic subgroups; the annual average of age-adjusted death rates from all cirrhosis was highest for Puerto Ricans and Mexicans and lowest for Cubans, among both males and females.
Cirrhosis Mortality Trends
While the age-adjusted all-cause mortality rate declined by 34.5 percent from 1970 to 2004, the age-adjusted death rate from all liver cirrhosis declined for the same period by 48.3 percent, from 17.8 to 9.2 deaths per 100,000 population. Rates for White males, Black males, White females, and Black females declined by 44.4, 68.3, 42.1, and 75.0 percent, respectively.
The age-adjusted death rate from all liver cirrhosis for males was consistently more than twice the rate for females, regardless of race.
The age-adjusted death rate from alcohol-related liver cirrhosis declined by 34.9 percent, from 6.3 deaths per 100,000 population in 1970 to 4.1 deaths per 100,000 population in 2004. Rates for White males, Black males, White females, and Black females declined by 23.5, 67.1, 29.0, and 75.9 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. To achieve this goal, the age-adjusted death rates from cirrhosis must decrease by 16 percent per year from 2005 through 2010.
INTRODUCTION
This surveillance report on liver cirrhosis is one of a series of four reports published annually 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, 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 changes toward meeting the Nation’s health promotion and disease prevention objective to reduce liver cirrhosis mortality as stated in Healthy People 2010 (Department of Health and Human Services [DHHS] 2000).
Cirrhosis of the liver is an outcome of 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 estabished that alcohol consumption is a major contributor in 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 the following 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, no method currently 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 some stigma still exists for 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 2004, 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
Sources and Limitations of Data
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 through 2004 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. Mortality statistics for the years 1910 through 1969 were taken from special reports published by NCHS, as summarized and described in an NIAAA data reference manual on cirrhosis mortality (NIAAA 1985). These reports were prepared from numbers obtained through State death registration offices. Prior to 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 by race and Hispanic origin from 2000 through 2004 came from bridged-race Vintage postcensal estimates of the resident population of the United States, developed for NCHS by the U.S. Census Bureau (NCHS 2003b; NCHS 2004; NCHS 2005; NCHS 2006). 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 2003a). Population data for 1970 through 1989 came from estimates developed for the National Cancer Institute (NCI) by the U.S. Census Bureau (NCI 2002). Population data for 1910 through 1969 were estimated using the numbers of cirrhosis deaths and the age-specific death rates reported in an NIAAA data reference manual on cirrhosis mortality (NIAAA 1985). Population data for Hispanic subgroups from 2000 through 2004 came from estimates based on the U.S. Census Bureau’s Current Population Survey (U.S. Census Bureau 2000–2004).
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 (introduced in 1968, 1979, and 1999, respectively) provide for coding categories of cirrhosis with and without mention of alcohol. The eighth revision, abbreviated ICDA-8, was specially adapted for use in the United States. The ninth revision, ICD-9, uses different categories for cirrhosis than ICDA-8. The tenth revision, ICD-10, uses twice as many categories for cirrhosis as ICD-9. To examine trends for comparable diseases from 1970 through 2004, 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 following page. As can be seen under ICD-10 in the crosswalk table, 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 deaths. 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 estimating 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..
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 liver571.2 Alcoholic cirrhosis of liver K70.9 Alcoholic liver disease, unspecified 571.3 Alcoholic liver damage, unspecified K70.4 Alcoholic hepatic failure1 303 & Alcohol dependence
572.8 syndrome and chronic hepatic failureK73.0 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, unspecified571.4 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, unspecified571.6 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 liver571.5 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.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 estimating 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.
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. In order to provide uniformity and comparability of the data, 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). However, prior to 1991, substantial proportions of decedents were missing ethnic identification, and Hispanic origin measures were not usable. Beginning with the 1999 issue of this report (Saadatmand et al. 1999), trend data on Hispanic origin were presented for the years of 1991 and later.
The first year in which all 50 States and the District of Columbia included Hispanic origin of decedents on their death certificates was 1997. In 2004 only 0.3 percent of cirrhosis decedents had an “unknown” classification for Hispanic origin. From 1991 through 2004 the percentage of cirrhosis deaths with Hispanic origin unknown was less than 2 percent for both Black and White decedents. 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 are often considered as 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 in 2007, 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 does not permit either comparisons of mortality among various population subgroups or 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—Unadjusted (or crude) death rates 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 be different 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—Age-specific death 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—Age-adjusted death rates 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.
The age distribution of the 1940 U.S. population was used as the standard to calculate all age-adjusted rates in issues of this surveillance report published before 2002. During the period from 1940 to 2000 the proportion of the U.S. population ages 65 years and older almost doubled (from 6.8 percent to 12.6 percent). To better reflect the current population age structure, the U.S. Department of Health and Human Services (1998) requires the use of the year 2000 standard population with mortality data for 1999 and later years. Therefore, beginning with the year 2002 issue of this report, all age-adjusted death rates have been computed based on the 2000 standard population, replacing the previously published rates based on the 1940 standard population.1
1 Standard population age distribution:
Number
Age group 0 to 4 years 80,061 69,135 5 to 14 years 170,355 145,565 15 to 24 years 181,677 138,646 25 to 34 years 162,066 135,573 35 to 44 years 139,237 162,613 45 to 54 years 117,811 134,834 55 to 64 years 80,294 87,247 65 to 74 years 48,426 66,037 75 to 84 years 17,303 44,842 85+ years 2,770 15,508 All ages 1,000,000 1,000,000 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 calculated by adding the expected deaths for each age group and then dividing this sum by the total population taken as the standard.
Rates for Hispanic subgroups are based on 5-year averages of age-specific and age-adjusted cirrhosis death rates in order to increase the reliability of these estimates. Since 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.
Department of Health and Human Services. HHS Policy for Changing the Population Standard for Age Adjusting Death Rates. Memorandum from the Secretary. Available on the DHHS Web site at 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: U.S. Government Printing Office, 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.
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.
Mann, R.E.; Smart, R.G.; and Govoni, R. The epidemiology of alcoholic liver disease. Alcohol Research & Health 27(3):209–219, 2003.
National Cancer Institute. U.S. Population Data. Available on the NCI Web site at http://seer.cancer.gov/popdata/download.html. 2002.
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: U.S. Government Printing Office, 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/about/major/dvs/popbridge/popbridge.htm), April 15, 2003a.
National Center for Health Statistics. Estimates of the July 1, 2000–July 1, 2002, United States resident population from the Vintage 2002 postcensal series by year, county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau (http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm), August 1, 2003b.
National Center for Health Statistics. Estimates of the July 1, 2000–July 1, 2003, United States resident population from the Vintage 2003 postcensal series by year, county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau (http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm), September 14, 2004.
National Center for Health Statistics. Estimates of the July 1, 2000–July 1, 2004, United States resident population from the Vintage 2004 postcensal series by year, county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau (http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm), September 9, 2005.
National Center for Health Statistics. Estimates of the July 1, 2000–July 1, 2005, United States resident population from the Vintage 2005 postcensal series by year, county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau (http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm), August 16, 2006.
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.
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.
Saadatmand, F., Stinson, F.S., Grant, B.F., and Dufour, M.C. Surveillance Report #52: Liver Cirrhosis Mortality in the United States, 1970–96. Rockville, MD: NIAAA, DBE, AEDS, 1999.
U.S. Census Bureau. Population by Sex, Age, and Hispanic Origin Type: March 2000, Current Population Survey, March 2000, Ethnic and Hispanic Statistics Branch, Population Division (http://www.census.gov/ population/socdemo/hispanic/ppl-171/tab01-2.txt), 2000.
U.S. Census Bureau. Population by Sex, Age, and Hispanic Origin Type: March 2001, Current Population Survey, March 2001, Ethnic and Hispanic Statistics Branch, Population Division (http://www.census.gov/ population/socdemo/hispanic/ppl-172/tab01-2.txt), 2001.
U.S. Census Bureau. Population by Sex, Age, and Hispanic Origin Type: March 2002, Current Population Survey, March 2002, Ethnic and Hispanic Statistics Branch, Population Division (http://www.census.gov/ population/socdemo/hispanic/ppl-165/tab01-2.txt), 2002.
U.S. Census Bureau. Population by Sex, Age, and Hispanic Origin Type: 2003, Current Population Survey, Annual Social and Economic Supplement, 2003, Ethnicity and Ancestry Statistics Branch, Population Division (http://www.census.gov/population/socdemo/hispanic/ASEC2003/2003CPS_tab1.2b.txt; http://www.census.gov/ population/ socdemo/hispanic/ASEC2003/ 2003CPS_tab1.2c.txt), 2003.
U.S. Census Bureau. Population by Sex, Age, and Hispanic Origin Type: 2004, Current Population Survey, Annual Social and Economic Supplement, 2004, Ethnicity and Ancestry Statistics Branch, Population Division (http://www.census.gov/population/socdemo/hispanic/ASEC2004/ 2004CPS_tab1.2b.txt; http://www.census.gov/ population/socdemo/hispanic/ASEC2004/ 2004CPS_tab1.2c.txt), 2004.
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.
List of Figures
Figure 1. Age-adjusted death rates from liver cirrhosis by sex (death registration States, 1910–1932, and United States, 1933–2004).
Figure 2. Age-adjusted death rates of liver cirrhosis by sex and race, United States, 1970–2004.
Figure 3. Age-specific death rates of liver cirrhosis, United States, 1970–2004.
Figure 4. Age-specific death rates of liver cirrhosis by race and sex, United States, 1970–2004.
Figure 5. Age-adjusted death rates of liver cirrhosis by sex, race, and Hispanic origin, United States, 1970–2004.
Figure 6. Age-adjusted death rates of liver cirrhosis reported with and without mention of alcohol, United States, 1970–2004.
Figure 7. Percent of all cirrhosis deaths coded as alcohol-related by age, United States, 1970–2004.
Figure 8. Age-adjusted death rates of alcohol-related liver cirrhosis by sex, race, and Hispanic origin, United States, 1970–2004.
Figure 9. Age-adjusted death rates of specified liver cirrhosis without mention of alcohol by sex, race, and Hispanic origin, United States, 1970–2004.
Figure 10. Age-adjusted death rates of unspecified liver cirrhosis without mention of alcohol by sex, race, and Hispanic origin, United States, 1970–2004.
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, 2000–2004.
List of Tables
Table 1. Age-adjusted death rates from liver cirrhosis by sex (death registration States, 1910–1932, and United States, 1933–2004).
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, 1970–2004.
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, 1970–2004.
Table 4. Age-adjusted death rates from liver cirrhosis with and without mention of alcohol by sex, race, and Hispanic origin, United States, 1970–2004.
Table 5. Age-specific number of deaths, 5-year annual average of age-specific death rates, and age-adjusted death rates from all liver cirrhosis by Hispanic subgroup and sex, United States, 2000–2004.
Table 6. Age-specific number of deaths, 5-year annual 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, 2000–2004 .
Figure 1. Age-adjusted death rates from liver cirrhosis by sex (death registration States, 1910–1932, and United States, 1933–2004).
Data for figure 1 are presented in Table 1.
Note: Because there was no information available on deaths by sex for 1910—1913 and 1917, age-adjusted death rates
for males and females based on the year 2000 standard population were not calculated for these years.
Figure 2. Age-adjusted death rates of liver cirrhosis by sex and race, United States, 1970–2004.
Data for figure 2 are presented in Table 2.
Figure 3. Age-specific death rates of liver cirrhosis, United States, 1970–2004.
Data for figure 3 are presented in Table 2.
Figure 4. Age-specific death rates of liver cirrhosis
by race and sex, United States, 1970–2004.
Note: Different age groups have different vertical scales
(i.e., rates vary substantially by age).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, 1970–2004.
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, 1970–2004.
Data for figure 6 are presented in Table 3.
Figure 7. Percent of all cirrhosis deaths coded as alcohol-related by age, United States, 1970–2004.
Data for figure 7 are presented on the following page.
Figure 8. Age-adjusted death rates of alcohol-related liver cirrhosis by sex, race, and Hispanic origin, United States, 1970–2004.
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, 1970–2004.
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, 1970–2004.
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, 2000–2004
Data for figure 11 are presented in Table 6.
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