Dataset Information

Mortality From Alcohol-Related Liver Cirrhosis in Mexico (2000-2017).

ABSTRACT: Background: Alcohol is the main cause of liver cirrhosis. The objective of this study was to analyze the mortality rates of alcohol-related cirrhosis in Mexico from 2000 to 2017. Methods: Mortality data from alcohol-related cirrhosis were obtained from the National Institute of Statistics and Geography. Rates were adjusted to the World Standard Population and were calculated with a direct method. The differences between genders were evaluated with Student's t-test, while the ANOVA test was used for differences among age groups. A trend analysis was performed with an ln regression of adjusted mortality rates and analyzed with Student's t-test. Results: The mean age-adjusted mortality rate during the study period was 13.28 per 100,000 inhabitants. A significant decrease in mortality rates was observed, from 20.55 to 10.62 per 100,000 inhabitants. All age groups studied showed a significant decrease in mortality. The mortality rate was higher in males than in females. Conclusions: Mortality from alcohol-related cirrhosis decreased in Mexico. Males still have the highest mortality rate.

SUBMITTER: Yeverino-Gutierrez ML

PROVIDER: S-EPMC7644839 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Mortality From Alcohol-Related Liver Cirrhosis in Mexico (2000-2017).

Yeverino-Gutiérrez Myrna L ML González-González María Del R MDR González-Santiago Omar O

Frontiers in public health 20201023

Background: Alcohol is the main cause of liver cirrhosis. The objective of this study was to analyze the mortality rates of alcohol-related cirrhosis in Mexico from 2000 to 2017. Methods: Mortality data from alcohol-related cirrhosis were obtained from the National Institute of Statistics and Geography. Rates were adjusted to the World Standard Population and were calculated with a direct method. The differences between genders were evaluated with Student's t-test, while the ...[more]

PMID: 33194939

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Project description:Background & aimsSex-based differences are known to significantly contribute to outcomes in patients with chronic liver diseases; however, the role of patient sex in cirrhosis is unclear. We aimed to study the relationship between patient sex and cirrhosis.MethodsWe analyzed a cohort of 20,045 patients with cirrhosis using a Chicago-wide electronic health record database that was linked with the United Network for Organ Sharing and cause of death data from the state death registry. Adjusted Cox survival analyses and competing risk analyses were performed to obtain subdistribution hazard ratios (HRs) for liver-related cause of death.ResultsFemale and male patients had similar age, racial distribution, insurance status, and comorbidity status by Elixhauser score. Females had higher rates of cholestatic liver disease (17.1% vs. 6.2%, p <0.001) and non-alcoholic steatohepatitis (29.8% vs. 21.2%, p <0.001) than males. They were less likely to have portal hypertensive complications and had lower peak MELD-Na scores during follow-up. Female sex was associated with a decreased hazard of all-cause mortality (adjusted HR 0.85; 95% CI 0.80-0.90). This effect was attenuated when liver-related mortality was examined (subdistribution HR 0.93; 95% CI 0.87-1.00). No significant difference was noted for women who were 'ever-listed' in competing risk analyses for either all-cause mortality (subdistribution HR 1.09; 95% CI 0.88-1.35) or liver-related death (subdistribution HR 1.12; 95% CI 0.87-1.43), despite lower rates of listing (7.5% vs. 9.8%; p <0.001) and transplant (3.5% vs. 5.2%; p <0.001).ConclusionsIn this longitudinal study of patients with cirrhosis, female sex was associated with a survival advantage likely driven by lower rates of non-liver-related death. Women were not at an increased risk of liver-related death despite lower rates of listing and transplantation.Lay summaryPatient sex is an important contributor in many chronic diseases, including cirrhosis. Prior studies have suggested that female sex is associated with worse outcomes. We analyzed a cohort of 20,045 patients with cirrhosis using a Chicago-wide electronic health record database. Using multivariate competing risk analyses, we found that female sex in cirrhosis is actually associated with a lower risk of all-cause mortality and has no association with liver-related mortality. Our findings are novel because we show that women with cirrhosis have a similar risk of liver-related death as their male counterparts, despite lower rates of listing and transplantation.

Project description:ImportanceLife expectancy has decreased in the US, driven largely by increases in drug poisoning, suicide, and alcohol-induced deaths. Assessing whether patterns of these causes differ is required to inform public health interventions.ObjectiveTo compare patterns and trends in drug poisoning, suicide, and alcohol-induced death rates by geography and demographic characteristics.Design, setting, and participantsThis serial cross-sectional study used national vital statistics data from the entire US population from January 1, 2000, to December 31, 2017, among US residents aged 20 to 64 years. Data were analyzed from January through August 2019.ExposuresAge, sex, race/ethnicity, county-level percentage of unemployment, rurality, and geography.Main outcomes and measuresDeaths were categorized as due to drug poisoning, suicide, or alcohol-induced causes based on underlying cause of death. Age-standardized incidence rates and annual percentage changes (APCs) in rates were estimated. Clusters of high-rate counties were identified with hot spot analysis. Excess deaths during 2001 to 2017 were estimated for each cause as the difference between the number of deaths observed and expected if rates had remained stable starting in 2000.ResultsDuring 2000 to 2017, 1 446 177 drug poisoning, suicide, and alcohol-induced premature deaths occurred in the US, including 563 765 drug poisoning deaths (age-standardized rate: 17.6 per 100 000 person-years [PYs]), 517 679 suicides (age-standardized rate: 15.8 per 100 000 PYs), and 364 733 alcohol-induced deaths (age-standardized rate: 10.5 per 100 000 PYs), totaling 451 596 more deaths than expected based on 2000 rates. High drug poisoning death rates were clustered in the Northeast through Appalachia, yet rates of suicide and alcohol-induced deaths were highest in the West. Only suicide death rates were highest in rural areas. Drug poisoning death rates were highest among people aged 35 to 49 years (age-standardized rate: 23.7 per 100 000 PYs), whereas suicide and alcohol-induced death rates peaked among people aged 50 to 64 years (suicide age-standardized rate: 19.6 per 100 000 PYs; alcohol-induced age-standardized death rate: 26.8 per 100 000 PYs). Increases occurred over time across racial/ethnic groups, although trajectories and inflection years varied. Drug poisoning (2013-2017 APC, 15.0% [95% CI, 11-8%-18.3%] per year) and alcohol-induced death rates (2012-2017 APC, 4.1% [95% CI, 3.3%-4.9%] per year) have accelerated recently, while increases in suicide death rates have largely increased at a constant trajectory (2000-2017 APC, 1.8% [95% CI, 1.7%-1.9%] per year).Conclusions and relevanceThis cross-sectional study found that demographic characteristics and geographic patterns varied by cause of death, suggesting that increasing death rates from these causes were not concentrated in 1 group or region. Specialized interventions tailored for the underlying drivers of each cause of death are urgently needed.

Dataset Information

Mortality From Alcohol-Related Liver Cirrhosis in Mexico (2000-2017).

Publications

Mortality From Alcohol-Related Liver Cirrhosis in Mexico (2000-2017).

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