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Peer-reviewedCC BY-NC 4.0BMJ Open Gastroenterology

Mortality trends in alcohol-related liver disease and chronic hepatitis and fibrosis or cirrhosis not coded as alcohol-related: a population-based analysis of US CDC WONDER data, 1999–2020

  • Ravi Kumar Pandey1
  • Muhammad Ahmad2
  • Iqra Moatter Nurie3
  • Aliya Noor4
  • Ali Rohan5
5 affiliations
  1. 1Nepalgunj Medical College, Nepalgunj, Nepal
  2. 2Sharif Medical and Dental College, Lahore, Pakistan
  3. 3Baqai Medical University, Karachi, Pakistan
  4. 4King Edward Medical University, Lahore, Pakistan
  5. 5The University of Lahore, University College of Medicine and Dentistry, Lahore, Pakistan
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Abstract

Objective: To compare US mortality trends for alcohol-related liver disease coded as K70 with chronic hepatitis and fibrosis or cirrhosis coded as K73–K74 and not coded as alcohol-related, and to quantify changes in standardised rates, death counts, counterfactual mortality and age–period–cohort patterns.

Methods: We analysed US CDC wide-ranging online data for epidemiological research (CDC WONDER) underlying-cause of death data for 1999–2020. Alcohol-related liver disease was defined by ICD-10 K70; the comparison category comprised K73–K74. National trends were assessed using joinpoint regression. Changes between pooled 2000–2002 and 2017–2019 rates were evaluated using direct standardisation and Das Gupta decomposition. Counterfactual deaths were estimated by applying pooled 2000–2002 age-specific rates to subsequent populations. Age–period–cohort models estimated identifiable temporal functions.

Results: From 1999 through 2020, 373 302 K70 deaths and 369 661 K73–K74 deaths occurred. The K70 age-adjusted mortality rate increased from 4.34 to 7.86 per 100 000; the average annual percentage change was 2.73% (95% CI 2.26% to 3.09%). The K73–K74 rate changed from 5.21 to 5.42 per 100 000, with a non-significant average annual change of 0.15% (95% CI −0.05% to 0.34%). Between 2000–2002 and 2017–2019, standardised K70 mortality increased by 2.90 per 100 000, whereas K73–K74 mortality decreased by 0.40 per 100 000; K70 accounted for 116.2% of the increase within the combined analytic universe. Mean annual deaths increased by 16 040, of which population size, age structure and mortality rates accounted for 6576, 3728 and 5736 deaths, respectively. During 2003–2019, 49 373 more K70 deaths and 15 449 fewer K73–K74 deaths occurred than expected. Relative K70 increases were fastest at ages 25–34 years, whereas the largest excess-death burden occurred at ages 50–64 years. K70 net drift was 2.684% annually; K73–K74 net drift was −0.252% and non-significant.

Conclusion: K70 mortality increased substantially, while K73–K74 mortality changed comparatively little. These findings apply to the prespecified cause-code categories and do not represent a comparison with all other chronic liver diseases.

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Cite

BibTeXRIS
BibTeX
@article{pandey2026mortality,
  title = {{Mortality trends in alcohol-related liver disease and chronic hepatitis and fibrosis or cirrhosis not coded as alcohol-related: a population-based analysis of US CDC WONDER data, 1999–2020}},
  author = {Ravi Kumar Pandey and Muhammad Ahmad and Iqra Moatter Nurie and Aliya Noor and Ali Rohan},
  journal = {BMJ Open Gastroenterology},
  year = {2026},
  month = nov,
  doi = {10.1136/bmjgast-2026-002458},
  url = {https://doi.org/10.1136/bmjgast-2026-002458},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Mortality trends in alcohol-related liver disease and chronic hepatitis and fibrosis or cirrhosis not coded as alcohol-related: a population-based analysis of US CDC WONDER data, 1999–2020
AU  - Ravi Kumar Pandey
AU  - Muhammad Ahmad
AU  - Iqra Moatter Nurie
AU  - Aliya Noor
AU  - Ali Rohan
PY  - 2026
DA  - 2026/11/04
JO  - BMJ Open Gastroenterology
DO  - 10.1136/bmjgast-2026-002458
UR  - https://doi.org/10.1136/bmjgast-2026-002458
AB  - Objective: To compare US mortality trends for alcohol-related liver disease coded as K70 with chronic hepatitis and fibrosis or cirrhosis coded as K73–K74 and not coded as alcohol-related, and to quantify changes in standardised rates, death counts, counterfactual mortality and age–period–cohort patterns.  Methods: We analysed US CDC wide-ranging online data for epidemiological research (CDC WONDER) underlying-cause of death data for 1999–2020. Alcohol-related liver disease was defined by ICD-10 K70; the comparison category comprised K73–K74. National trends were assessed using joinpoint regression. Changes between pooled 2000–2002 and 2017–2019 rates were evaluated using direct standardisation and Das Gupta decomposition. Counterfactual deaths were estimated by applying pooled 2000–2002 age-specific rates to subsequent populations. Age–period–cohort models estimated identifiable temporal functions.  Results: From 1999 through 2020, 373 302 K70 deaths and 369 661 K73–K74 deaths occurred. The K70 age-adjusted mortality rate increased from 4.34 to 7.86 per 100 000; the average annual percentage change was 2.73% (95% CI 2.26% to 3.09%). The K73–K74 rate changed from 5.21 to 5.42 per 100 000, with a non-significant average annual change of 0.15% (95% CI −0.05% to 0.34%). Between 2000–2002 and 2017–2019, standardised K70 mortality increased by 2.90 per 100 000, whereas K73–K74 mortality decreased by 0.40 per 100 000; K70 accounted for 116.2% of the increase within the combined analytic universe. Mean annual deaths increased by 16 040, of which population size, age structure and mortality rates accounted for 6576, 3728 and 5736 deaths, respectively. During 2003–2019, 49 373 more K70 deaths and 15 449 fewer K73–K74 deaths occurred than expected. Relative K70 increases were fastest at ages 25–34 years, whereas the largest excess-death burden occurred at ages 50–64 years. K70 net drift was 2.684% annually; K73–K74 net drift was −0.252% and non-significant.  Conclusion: K70 mortality increased substantially, while K73–K74 mortality changed comparatively little. These findings apply to the prespecified cause-code categories and do not represent a comparison with all other chronic liver diseases.
SN  - 2054-4774
ER  -