Rural-Urban Disparities in Mortality Related to Alcohol-Associated Liver Disease by Race/Ethnicity in the United States From 1999 to 2022.

INTRODUCTION

Mortality related to alcohol-associated liver disease (ALD) has been increasing over the past two decades, especially in racial and ethnic minorities and those living in rural areas. The interaction between rurality, race and ethnicity in mortality disparities is unclear.

METHODS

This cross-sectional study extracted data from the Underlying Cause of Death database of CDC Wide-Ranging Online Database for Epidemiological Research (1999-2022). We estimated the age-adjusted mortality rates (AAMRs) for ALD among adults 25 years and older. We calculated the average annual percentage change (AAPC) using the Joinpoint regression program.

RESULTS

There were 436,814 deaths related to ALD among US adults with rising mortality from 1999 (AAMR, 6.7) to 2022 (AAMR, 12.5) (AAPC, 2.7%). American Indian and Alaska Native (AI/AN) individuals had the highest mortality in 2022 (AAMR, 76.8), followed by Hispanic individuals (AAMR, 14.1). Mortality increases in non-Hispanic White (NHW) individuals (AAPC, 4.0%) surpassed that of non-Hispanic Black (NHB) individuals (AAPC, 0.4%). The increase in AAMR was more pronounced in rural areas (AAPC, 4.1%) than large metropolitan areas (AAPC, 2.0%). For NHW, AI/AN, and Hispanic individuals, AAMRs in rural areas had greater increases than in large metropolitan areas. AAMRs remained largely stable in large metropolitan (AAPC, - 0.6%) and rural areas for NHB individuals (AAPC, 0.1%).

DISCUSSION: There were significant and widening rural-urban disparities in ALD-related mortality among NHW, AI/AN, and Hispanic individuals. Mortality in NHB individuals remained largely stable. Targeted resources and efforts are essential to address the growing mortality burden in select populations.