Yk. Shim et al., FACTORS ASSOCIATED WITH THE DECLINE IN CIRRHOSIS DEATH RATES AMONG YOUNG-ADULTS IN ALLEGHENY COUNTY, PENNSYLVANIA, 1973-1985, American journal of epidemiology, 138(7), 1993, pp. 531-543
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.