FACTORS ASSOCIATED WITH THE DECLINE IN CIRRHOSIS DEATH RATES AMONG YOUNG-ADULTS IN ALLEGHENY COUNTY, PENNSYLVANIA, 1973-1985

From 1973 to 1985, the age-adjusted death rate from liver cirrhosis (I nternational Classification of Diseases, Ninth Revision, code 571) dro pped by 62.7% among adults aged 25-54 years in Allegheny County, Penns ylvania. The authors investigated factors associated with this decline by verifying causes of death on death certificates from medical recor ds, coroner's reports, and autopsy reports. Although death rates from cirrhosis were slightly underestimated from death certificates, the un derestimation did not alter the declining mortality trend. This declin e in rates was significant after adjustment of the age, sex, and race effect using statistical modeling. No significant variability in the t ime trends was noted between sexes, races, and age groups. Neither did the trends in alcohol-related and ''unspecified'' cirrhosis differ. H owever, the trends varied significantly between the cirrhosis deaths c ertified by the coroner and by noncoroner physicians. From 1973-1975 t o 1976-1978, the rate initially dropped by 51% among the coroner cases , whereas it dropped by only 9% among the noncoroner cases. By the per iod 1982-1985, the death rates of both coroner and noncoroner cases de clined to approximately 50% of their 1973-1975 rates. These results su ggest that the decline during the years 1973-1985 was real and that th e trend was initiated by the pronounced decline during the early years in the coroner-certified cirrhosis deaths.