Cirrhosis Mortality Sees Major Rise in Rural Areas

Age-adjusted mortality rates (AAMRs) associated with cirrhosis increased significantly during the period 1999-2019, with higher AAMRs occurring in rural areas and especially among middle-aged adults, women, non-Hispanic Whites, and Native Americans, investigators reported in The American Journal of Gastroenterology.

“Overall, cirrhosis AAMRs increased from 11.6 in 1999 to 14.8 in 2019, with an increase from 11.7 to 13.0 in urban (APC = 0.6% [95% confidence interval (CI) 0.3%–1.0%]), 11.7–16.7 in medium/small metropolitan (APC = 1.9% [95% CI 1.6%–2.2%]), and 11.4 to 18.3 in rural areas (APC = 2.7% [95% CI 2.3%–3.2%]),” the researchers wrote.

The increase in mortality rates associated with cirrhosis among women across all regions mirrors observed trends of rising alcohol use disorder in this population. During the same period, absolute AAMRs decreased among non-Hispanic Black and Hispanic residents, particularly in large metropolitan areas, is encouraging. Across rural, large metropolitan, and medium to small cities the highest AAMRs were found among adults older than 65 years, men, and Native American/Alaska Native individuals.

Noting that patients with cirrhosis in rural areas may have excess mortality due to reduced access to hepatology specialists and to distance from liver transplantation centers, the researchers determined that their findings have important policy implications. They suggest “expanding access to alcohol use disorder treatment and implementing of restrictive alcohol control policies may decrease the burden of alcohol-related liver disease in rural areas,” and further call for development of “academic and community partnerships to expand telehealth services” to improve access to hepatology and transplant specialty services.  

“Disease stigma and late detection may be contributing to these findings,” they added, “and there needs to be increased investment in advocacy, policy, and research efforts focused on increasing national awareness of liver disease.”

—Rebecca Mashaw

Reference:

Ufere NN, Patzer RE, Kavalieratos D, Louissaint J, Kaplan A, Cross SH. Rural-urban disparities in mortality from cirrhosis in the United States from 1999 to 2019. Am J Gastroenterol. 2022;117(7):1162-1165. doi: 10.14309/ajg.0000000000001712