Reported in today's Alcoholism: Clinical and Experimental Research (Volume 25, Number 8), the findings have immediate implications for research and health practice and potential impact on health policy directions. "The new Hispanic ethnicity distinction on certificates of death corrects the decades-old belief that black males are at greatest risk of cirrhosis death. Clinicians should be newly alert to the risk for white Hispanic males," said NIAAA Deputy Director Mary C. Dufour, M.D., one of the study authors. Dr. Dufour also serves as Director of NIAAA's Division of Biometry and Epidemiology, the NIAAA component that performed the analysis.
"This dramatic finding from 1997 warrants close reexamination as data for subsequent years become available," said Dr. Dufour. "In addition, NIAAA will examine cirrhosis mortality by state to identify any possible influences of environment and point up implications for health services delivery."
In 1997, liver cirrhosis was the 10th leading cause of death and accounted for approximately 25,000 U.S. deaths, more than half of which were from alcohol-related cirrhosis. Since national cirrhosis mortality data were first reported in 1910, the mortality rate was highest in 1911 (17 deaths per 100,000 population), then declined steadily to 8 deaths per 100,000 population in 1932. With the repeal of Prohibition in 1933, cirrhosis mortality began an almost steady increase to 14.9 deaths per 100,000 population in 1973, followed by an almost steady decrease to 7.4 deaths per 100,000 population in 1997.
Cirrhosis death rates throughout the 1900s were almost twice as high for men as for women. In the 1970s, researchers observed sharply increased rates among black men. In 1989, the U.S. Standard Certificate of Death was revised to include Hispanic origin of the decedent, which allowed for the study of racial/ethnic groups such as white Hispanic, white non-Hispanic, black Hispanic, and black non-Hispanic. These designations accounted for 96 percent of the U.S. population during the 1990s, according to lead study author Frederick S. Stinson, Ph.D.
"Rates of cirrhosis death remain high among black non-Hispanic men and women but are considerably higher among white Hispanic men and women. Our results demonstrate the importance of the Hispanic designation in epidemiologic research but complicate the search to explain the observed differences among racial and ethnic groups," Dr. Stinson said.
Increased risk for liver cirrhosis deaths among white Hispanic males may be explained by different drinking patterns among population subgroups or other factors. Some Hispanic groups, especially those of Mexican and Central American heritage, have a drinking style marked by the periodic consumption of large amounts of alcohol. Other candidate factors include socioeconomic status and its component dimensions of income, occupation, and poverty status, all of which directly affect the use of medical care services.
"Although an advance over earlier systems, current racial/ethnic classifications of mortality data ignore the extraordinary heterogeneity within defined groups," cautions Bridget F. Grant, Ph.D., Ph.D., NIAAA Biometry Branch Chief and second author of today's study. "This is especially important for understanding U.S. liver cirrhosis deaths, as studies consistently demonstrate great variation in drinking patterns by ethnic origin within racial categories."
"Doctors and other health care workers need to be aware of the increased risk of cirrhosis death in white Hispanic males in order to advise them of risks that seem to be associated with specific drinking patterns."
For interviews with the study authors please telephone the NIAAA Press Office: 301/443-0595. Additional alcohol research information and publications are available at http://www.niaaa.nih.gov.
The National Institute on Alcohol Abuse and Alcoholism, a component of the National Institutes of Health, U.S. Department of Health and Human Services, conducts and supports approximately 90 percent of U.S. research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems and disseminates research findings to science, practitioner, policy making, and general audiences.