title: Mortality caused by chronic liver disease among American Indians and Alaska Natives in the United States, 1999-2009.
abstract: OBJECTIVE
  We compared chronic liver disease (CLD) mortality from 1999 to 2009 between American Indians and Alaska Natives (AI/ANs) and Whites in the United States after improving CLD case ascertainment and AI/AN race classification.
  
  
  METHODS
  We defined CLD deaths and causes by comprehensive death certificate-based diagnostic codes. To improve race classification, we linked US mortality data to Indian Health Service enrollment records, and we restricted analyses to Contract Health Service Delivery Areas and to non-Hispanic populations. We calculated CLD death rates (per 100,000) in 6 geographic regions. We then described trends using linear modeling.
  
  
  RESULTS
  CLD mortality increased from 1999 to 2009 in AI/AN persons and Whites. Overall, the CLD death rate ratio (RR) of AI/AN individuals to Whites was 3.7 and varied by region. The RR was higher in women (4.7), those aged 25 to 44 years (7.4), persons residing in the Northern Plains (6.4), and persons dying of cirrhosis (4.0) versus hepatocellular carcinoma (2.5), particularly those aged 25 to 44 years (7.7).
  
  
  CONCLUSIONS
  AI/AN persons had greater CLD mortality, particularly from premature cirrhosis, than Whites, with variable mortality by region. Comprehensive prevention and care strategies are urgently needed to stem the CLD epidemic among AI/AN individuals.
authors.affiliation: Anil Suryaprasad and Kathy K. Byrd are with the Division of Viral Hepatitis; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention (CDC); US Department of Health and Human Services; Atlanta, GA. John T. Redd is with the Santa Fe Public Health Service Indian Hospital, Indian Health Service, US Department of Health and Human Services, Santa Fe, NM. David G. Perdue is with the American Indian Cancer Foundation and Minnesota Gastroenterology PA, Minneapolis. M. Michele Manos is with the Kaiser Permanente Division of Research, Oakland, CA. Brian J. McMahon is with the Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AL.
authors.forename: Anil
authors.initials: A
authors.lastname: Suryaprasad
authors.forename: Kathy K
authors.initials: KK
authors.lastname: Byrd
authors.forename: John T
authors.initials: JT
authors.lastname: Redd
authors.forename: David G
authors.initials: DG
authors.lastname: Perdue
authors.forename: M Michele
authors.initials: MM
authors.lastname: Manos
authors.forename: Brian J
authors.initials: BJ
authors.lastname: McMahon
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology; D002423:Cause of Death; D002908:Chronic Disease; D003644:Death Certificates; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D008107:Liver Diseases / Q000208:ethnology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
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