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, 3 (11), 1459-1471
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Mortality Related to Nonalcoholic Fatty Liver Disease Is Increasing in the United States

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Mortality Related to Nonalcoholic Fatty Liver Disease Is Increasing in the United States

James M Paik et al. Hepatol Commun.

Abstract

Population-level nonalcoholic fatty liver disease (NAFLD) death rate data are sparse. We described death rates for adults with NAFLD in the United States using mortality data from the National Vital Statistics System multiple-cause mortality data (2007-2016). Decedents who had NAFLD were identified by International Classification of Diseases (ICD) codes K75.81, K76.0, K74.0, K74.6, and K76.9. Among NAFLD decedents, cause-specific deaths (e.g., cardiovascular disease [CVD], cirrhosis, hepatocellular carcinoma [HCC], non-liver cancer, diabetes mellitus [DM]) were identified by underlying cause of death ICD-10 codes. Trends were evaluated by average annual percentage change (AAPC) in age-standardized death rate (ASDR) per 100,000 persons. Among the 25,129,960 decedents aged ≥20 years, 353,234 (1.4%) decedents had NAFLD (212,322 men; 260,765 non-Hispanic whites, 32,868 non-Hispanic blacks, 46,530 Hispanics, 5,025 non-Hispanic American Indian or Alaska Natives [AIANs], 7,023 non-Hispanic Asian or Pacific Islanders [APIs]), with a mean age at death of 64.47 ± 13.17 years. During the study period, the ASDR for NAFLD increased by 15% (12.94 to 14.90; AAPC, 1.98%; P < 0.001]), while women (AAPC, 2.99% vs. 1.16% men; P = 0.003), non-Hispanic whites (AAPC, 2.48%), non-Hispanic AIANs (AAPC, 2.31%), and Hispanics (AAPC, 0.74%) experienced the highest annual increases. Stable trends were noted for non-Hispanic blacks and non-Hispanic APIs. Among subgroups, Mexican (AAPC, 1.75%) and Asian Indians (AAPC, 6.94%) experienced annual increases. The top six underlying causes of death (155,894 cirrhosis, 38,444 CVD, 19,466 non-liver cancer, 10,867 HCC, 8,113 DM, and 5,683 lung disease) accounted for 67.5% of NAFLD-related deaths. For cause-specific deaths, ASDR increased for HCC (AAPC, 3.82%), DM (AAPC, 2.23%), non-liver cancer (AAPC, 2.14%), CVD (AAPC, 1.59%), and cirrhosis (AAPC, 0.96%). Conclusion: NAFLD-related deaths in U.S. adults are increasing. Cirrhosis is the top cause-specific death, followed by CVD. Women, non-Hispanic whites, and non-Hispanic AIANs (subgroups Mexicans and Asian Indians) experienced the highest increases in deaths. Policies addressing the societal burden of NAFLD are needed.

Figures

Figure 1
Figure 1
Flow diagram. Abbreviations: CLD, chronic liver disease; w/o, without.
Figure 2
Figure 2
Age‐standardized death rates for NAFLD, United States, 2007‐2016. (A) By sex; (B) by race/ethnicity. 1Significant increasing trend from 2007 to 2016; 2significant increasing trend from 2007 to 2014 and stable trend from 2014 to 2016. Data markers denote observed rates; lines are fitted based on joinpoint analysis. Age standardization is based on the direct method to the Census 2000 population by 10‐year age groups. (From the National Center for Health Statistics, 2007‐2016.)
Figure 3
Figure 3
Age‐standardized death rates for NAFLD, United States, 2007‐2016. (A) Hispanic subgroup; (B) Asian American subgroup. 1Significant increasing trend from 2007 to 2016; 2significant increasing trend from 2007 to 2011 and stable trend from 2011 to 2016. Data markers denote observed rates; lines are fitted based on joinpoint analysis. Age standardization is based on the direct method to the Census 2000 population by 10‐year age groups. NAFLD‐related deaths are defined by ICD‐10 codes, using underlying or contributing cause of death noted on the death certificates. Because of small sample size and livability, an increasing or decreasing trend among Asian American subgroup are not statistically significant but among Asian Indians. See Table 5 AAPC column.

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