Regional Differences in Mortality Rates and Characteristics of Decedents With Hepatitis B Listed as a Cause of Death, United States, 2000-2019

Abstract

Importance: US hepatitis B mortality has been described nationally, but examination subnationally may identify differences in mortality rates and decedent characteristics, including birthplace.

Objective: To examine characteristics of decedents with hepatitis B-listed deaths during 2010 to 2019 and compare age-adjusted hepatitis B-listed death rates during 2010 to 2019 vs 2000 to 2009.

Design, setting, and participants: This cross-sectional study used Multiple Cause of Death data from 50 US states and the District of Columbia (DC) from 2000 to 2019 to assess characteristics of US residents with hepatitis B listed as an underlying cause of death (UCOD) or contributing cause of death on death certificates. Data were analyzed from September 2019 to May 2022.

Exposures: Hepatitis B listed as underlying or contributing cause of death.

Main outcomes and measures: Outcomes of interest were hepatitis B-listed death counts, age-adjusted rates, and characteristics of decedents during 2000 to 2019. The distribution of hepatitis B-listed deaths according to sociodemographic characteristics and UCOD among US- and non-US-born decedents were also examined.

Results: A total of 35 280 decedents with hepatitis B listed as the cause of death were identified, including 17 483 deaths during 2010 to 2019. Decedents were 63.3% US-born, and 25.8% of decedents were Asian or Pacific Islander and 46.5% of decedents were White; 28.4% of decedents were listed as having hepatitis C virus (HCV) or HIV coinfection. State-level rates significantly surpassed the overall US rate (0.47 deaths per 100 000 population) in DC (high, 1.78 deaths per 100 000 population), Hawaii, Oklahoma, California, Tennessee, West Virginia, Mississippi, Oregon, Washington, Louisiana, Kentucky, and New York (low, 0.61 deaths per 100 000 population). Median (IQR) age at hepatitis B death was significantly younger in Kentucky (54.0 [46.0-64.0] years), West Virginia (56.0 [47.0-65.0] years), Tennessee (57.0 [50.0-65.0] years), Mississippi (58.0 [50.0-65.0] years), and Ohio (59.0 [50.0-66.0] years) than the national median (60.0 [53.0-69.0] years), which itself was significantly younger than nonhepatitis B-listed deaths (77 [63.0-87.0] years; P < .001). Hepatitis B was the UCOD among approximately 30% of US- and non-US-born decedents with hepatitis B COD. Irrespective of birthplace, most decedents had liver-related UCOD. Compared with non-US-born decedents, US-born decedents more frequently had nonliver conditions listed as UCOD. Liver cancer was the predominant UCOD among non-US-born decedents (37.9% of decedents). From 2000 to 2009 compared with 2010 to 2019, the hepatitis B-listed mortality rate significantly decreased nationally (change, -18.97%) and in 14 states; significant increases were observed in West Virginia (change, 83.78%) and Kentucky (change, 69.44%).

Conclusions and relevance: These findings suggest that US-born decedents constituted two-thirds of all hepatitis B-listed deaths and median age at death was youngest in Appalachian states. Irrespective of birthplace, most decedents had liver-related UCOD; however, US-born decedents more frequently had nonliver UCOD than non-US-born decedents. In addition to addressing liver-related complications, US-born persons with chronic infection may also require diagnosis and management of multiple comorbidities.

Figure 1.. Age-Adjusted Hepatitis B–Listed Death Rates in 50 States and the District of Columbia, Segmented by Department of Health and Human Services Regions, United States, 2010-2019^a

Data are shown by decedent residence in the US states and the District of Columbia. Data Source: 2010-2019 US Multiple Cause of Death data, National Vital Statistics System. ^aThe hepatitis B–listed death rate for the United States in 2010 to 2019 was 0.47 (95% CI, 0.46–0.48) deaths per 100 000 population. ^bSignificantly younger median age at hepatitis B–listed death than the median age at hepatitis B–listed death for the United States (60.0 years). ^cSignificantly older median age at hepatitis B–listed death than the median age at hepatitis B–listed death for the United States. ^dRates where death counts were fewer than 20 are considered statistically unstable.

Figure 2.. Distribution of US Birthplace Status Among Hepatitis B–Listed Deaths, United States, 2010-2019

Data Source: 2010-2019 US Multiple Cause of Death data, National Vital Statistics System. US birthplace data for Alabama, Delaware, Montana, New Hampshire, North Dakota, South Dakota, Vermont, West Virginia, and Wyoming were not displayed because at least 1 cell (either US-born or non-US–born) had fewer than 10 deaths. Missing values were not included in calculations. ^aStatistically different based on the 95% CI of the proportion of hepatitis B–listed deaths for each state compared with the national distribution.