Liver Cirrhosis Mortality in the United States: National, State, and Regional Trends, 2000-2023 | NIAAA

Surveillance Report #123

Chiung M. Chen, M.A.
Hillel R. Alpert, Sc.D.

CSR, Incorporated¹
Suite 400

20130 Lakeview Center Plaza

Ashburn, VA 20147

September 2025

U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health

¹ CSR, Incorporated, operates the Alcohol Epidemiologic Data System (AEDS) under Contract No. 75N94023C00015 for the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Dr. Bradley Kerridge (Division of Epidemiology and Prevention Research) serves as the NIAAA Contracting Officer’s Representative on the contract.

Highlights

This surveillance report, prepared biennially by the Alcohol Epidemiologic Data System (AEDS), National Institute on Alcohol Abuse and Alcoholism (NIAAA), presents trends in liver cirrhosis mortality in the United States. Data on the underlying cause of death were compiled from public use data files published annually by the National Center for Health Statistics (NCHS). Population data from the U.S. Census Bureau and NCHS were used as denominators to calculate mortality rates.

The age-adjusted death rate from liver cirrhosis in the United States increased steadily, from 11.9 deaths per 100,000 population at the end of Prohibition in 1933 to a peak of 18.1 deaths per 100,000 population in 1973, and then steadily declined for three decades until 2006, at 9.0 deaths per 100,000 population. However, this trend reversed course and increased up to the COVID-19 pandemic era, reaching 15.5 deaths per 100,000 population in 2021, but dropped to 14.1 deaths per 100,000 population by 2023. Sex differences in alcohol-related liver cirrhosis, also known as alcohol-associated liver disease, mortality across ages reflected the consequences of a consistent but narrowing gender gap in alcohol consumption. The following are highlights of liver cirrhosis mortality in 2023 and its trends from 2000 through 2023.

Cirrhosis Mortality in 2023

In 2023, cirrhosis was the 9th leading cause of death in the United States, accounting for a total of 56,975 deaths—2,409 fewer than in 2022. The crude death rate from all cirrhosis was 17.0 deaths per 100,000 population, down 4.5 percent from the 2022 estimate of 17.8, and the rate from alcohol-related cirrhosis was 8.5, 7.8 percent lower than the 2022 estimate of 9.3.
Of all cirrhosis deaths, 50.3 percent (28,632 deaths) were alcohol related. The proportion of alcohol-related cirrhosis was highest (80.3 percent) among decedents ages 25 to 34, followed by decedents ages 35 to 44, at 75.6 percent. The gender gap in the proportion of alcohol-related cirrhosis was smaller among those who died before reaching age 55 than among those in older age groups.
The age-adjusted death rate from cirrhosis for Hispanic White males was 1.3 times the rate for non-Hispanic White males and 2.2 times the rate for non-Hispanic Black males. The rate for Hispanic White females was 1.1 times the rate for non-Hispanic White females and 1.9 times the rate for non-Hispanic Black females.
Wide variations existed across Hispanic subgroups. The 5-year annual average of the age-adjusted death rate from all cirrhosis was highest among Mexican-origin Hispanics and lowest among Cuban-origin Hispanics, in both males and females.

Cirrhosis Mortality Trends

Although the age-adjusted all-cause mortality rate declined by 13.6 percent from 2000 to 2023, the death rate from cirrhosis over the same period increased dramatically by 46.1 percent, from 9.7 to 14.1 deaths per 100,000 population. This rise was not uniform across racial groups. Rates for White males and females increased by 43.0 percent and 89.1 percent, respectively. By contrast, the rate for Black males declined by 21.8 percent, and the rate for Black females increased slightly by 1.8 percent.
The age-adjusted death rate from cirrhosis for males was approximately twice that of females (with the male-to-female ratio declining from 2.2 in 2000 to 1.7 in 2023), but the ratio varied slightly by race/Hispanic origin.
The age-adjusted death rate from alcohol-related cirrhosis surged by 72.2 percent, rising from 4.3 deaths per 100,000 population in 2000 to 7.4 deaths per 100,000 population in 2023. Specifically, rates for males and females increased by 51.2 percent and 125 percent, respectively. Among White males and females, the rates increased by 66.0 percent and 157 percent, respectively. However, the rate for Black males declined by 16.9 percent, and the rate for Black females increased by 9.7 percent.
The age-specific death rate from cirrhosis increased substantially between 2000 and 2023 across age groups: 25–34 (234 percent), 35–44 (49.8 percent), 45–54 (27.1 percent), 55–64 (56.0 percent), 65–74 (40.6 percent), 75–84 (43.5 percent), and 85 or older (65.5 percent).
Between 2000–2002 and 2021–2023, every state except the District of Columbia saw an increase in the 3-year average of the age-adjusted death rate from cirrhosis.

Healthy People 2030 Objectives

One of the objectives of Healthy People 2030 is to reduce age-adjusted death rates from cirrhosis, not including portal hypertension and fatty (change of) liver not elsewhere classified, to no more than 10.9 deaths per 100,000 population. To achieve this goal, the age-adjusted death rate must decrease by at least 2.5 percent per year from 2023 through 2030.

Introduction

This surveillance report on liver cirrhosis mortality is one of a series of three reports published biennially to monitor trends in alcohol consumption and alcohol-associated liver disease (or alcohol-related liver cirrhosis) mortality in the United States. These surveillance reports are prepared by the Alcohol Epidemiologic Data System (AEDS), Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), and are intended to be useful to researchers, policymakers, and other professionals interested in alcohol misuse and its long-term effects. The data are also essential in assessing progress toward meeting the Nation’s health promotion and disease prevention objective of reducing cirrhosis mortality, as stated in Healthy People 2030 (U.S. Department of Health and Human Services [HHS] n.d.).

Cirrhosis of the liver is an outcome caused by a variety of factors, including alcohol consumption, obesity, exposure to various drugs and toxic chemicals, viral hepatitis, and other viral and infectious diseases (Goldberg and Chopra 2024a; Huang et al. 2023b; Jain and Saxena 2024; Scaglione et al. 2015; Wahlang et al. 2013; Zakhari 2013). It has been well established that alcohol misuse is a major contributor to deaths from cirrhosis and the related condition of alcoholic hepatitis (Huang et al. 2023a; Mackowiak et al. 2024; Mann et al. 2003; Osna et al. 2017; Rehm and Shield 2019; Roerecke et al. 2019; Szabo and Mandrekar 2010). The recent decline in Hepatitis C deaths, due to improvements in treatment options (Kim et al. 2018; Lee and Terrault 2019; Pageaux et al. 2022), has increased the relative contribution of alcohol consumption to cirrhosis mortality.

Heavy and prolonged alcohol consumption are key determinants of liver disease development, with women being more susceptible than men (Ding et al. 2023; Kezer et al. 2021; Llamosas-Falcón et al. 2022, 2024; Hernández-Évole et al. 2024; Park et al. 2022). As the primary site for detoxification of alcohol by oxidation of its metabolites, the liver can undergo three pathologies: fatty liver, alcoholic hepatitis, and cirrhosis. Patients with cirrhosis are susceptible to infections and complications, and their prognosis is highly variable (Bajaj et al. 2021; Goldberg and Chopra 2024b; Piano et al. 2024; Premkumar and Anand 2022). Other than liver transplantation, no established medical treatment is capable of fully reversing liver damage, particularly in cases of advanced cirrhosis characterized by extensive scarring and severe vascular alterations (Dezső et al. 2022; Singh et al. 2017; Tapper and Parikh 2023). It is important to note that alcohol-associated liver disease is frequently diagnosed at later stages (Shah et al. 2019) and continued to be the primary reason for liver transplants among adults, representing 38.6% of all cases in 2022 (Kwong et al. 2024). In earlier stages, if patients with cirrhosis resulting from alcohol consumption abstain from further alcohol use, the consequences of this disease can be treated, and their lives can be prolonged (Crabb et al. 2020; Lackner et al. 2017; Xie et al. 2014). Early detection of liver fibrosis through screening, combined with integrated liver and addiction care—including interventions for alcohol misuse and strategies to prevent further liver damage—as well as the identification of vulnerable populations, is crucial for prolonging life expectancy and improving health disparities in liver cirrhosis (Anouti et al. 2024; Ginès et al. 2022; Haque et al. 2024; Jones et al. 2023; Kardashian et al. 2023; Singal et al. 2024).

The coding scheme used in the United States to classify cause of death is the International Classification of Diseases (ICD), a statistical classification of disease and injury widely used by countries supporting mortality reporting systems. ICD codes classify the cause of death from cirrhosis as either related to alcohol or not related to alcohol. However, because of the stigma associated with excessive alcohol use, some physicians and other officials who certify causes of death may not identify alcohol in the case of a death from cirrhosis in an effort to protect the decedent’s family members. Furthermore, it is difficult to determine the alcohol-relatedness of a cirrhosis death without knowing the decedent’s history of alcohol consumption. As a result, alcohol-associated liver disease mortality can be significantly underreported. For instance, from 2000 to 2023, the proportion of all cirrhosis deaths coded as alcohol related ranged from 43.6 to 54.3 percent (depending on year). However, some researchers believe alcohol might have contributed to a substantially higher proportion of all deaths from cirrhosis (Crabb et al. 2020; Haberman and Weinbaum 1990; Powell and Klatskin 1968; Puffer and Griffith 1967; Ramstedt 2003; Stein et al. 2016). Therefore, this surveillance report examines all cirrhosis deaths as well as those that are explicitly coded as alcohol related.

This report has been presenting national data since its first issue, published in 1986. Beginning with its 2014 issue, the report added data for States and Census Regions, and the report’s title was revised accordingly. The current report focuses on data in the 2000s and onward to closely monitor the emerging trends and patterns in cirrhosis mortality. To provide readers with a quick reference of the historical trend, the report retains one table and one figure on national total cirrhosis mortality from 1910 to the present. Detailed national data for 1970–1999 are available online in the 2012 issue of this report.

Data Sources

Death counts and rates in this report are based on a single underlying cause of each death, defined as “the disease or injury which initiated the train of morbid events leading directly or indirectly to death or circumstances of the accident or violence which produced the fatal injury” (National Center for Health Statistics [NCHS] 1982). This approach is consistent with other mortality statistics reported by NCHS.

Cirrhosis death records for national trends for 1970–2023 were extracted from public use mortality data files produced by NCHS. These data files contained individual records of each death occurring in the United States, except for data files for 1972, which contained only a 50-percent sample of all U.S. deaths. The deaths counted in this report are for U.S. residents only. Deaths of foreign residents in the United States are not counted. Cirrhosis death data for States and Census Regions for 2000–2023 were obtained from the CDC WONDER online mortality database using its query system.

Historical cirrhosis mortality rates for 1910–1969 (presented in Figure 1 and Table 1) were calculated using historical government documents made available online by NCHS. For 1910–1919, the data sources included the National Office of Vital Statistics special report (1956) and intercensal resident population estimates in death registration States developed by the Bureau of the Census and presented in Linder and Grove (1943). For 1920–1969, the data sources included the annual reports of the Mortality Statistics (Bureau of the Census 1922–1938) and Vital Statistics in the United States (Bureau of the Census 1939–1946; NCHS 1961–1974; National Office of Vital Statistics 1947–1951 and 1953–1960). Note that all historical mortality statistics were based on numbers obtained through State death registration offices. Before 1933, not all States collected death registration information. The changing number of death registration States impedes the process of obtaining comparable mortality data for the United States before 1933.

Population data from various estimates provided by the U.S. Census Bureau and NCHS were used as denominators for calculating mortality rates in this report. Appendix A lists the detailed data sources for population estimates at the national and State levels and for Hispanic subgroups.

Methods

Definitions and Subclassifications of Liver Cirrhosis

This report presents data for three major subcategories of liver cirrhosis: alcohol-related liver cirrhosis, specified liver cirrhosis without mention of alcohol, and unspecified liver cirrhosis without mention of alcohol (see the last column of the table “Crosswalk of ICD-10 codes to ICD-9 codes and ICDA-8 codes”). When the case numbers are small, the latter two subcategories are combined into one and labeled as “all other cirrhosis without mention of alcohol.”

During the long period (1910–2023) for which historical mortality statistics are shown in this report, cause of death was classified according to nine revisions of the ICD. The ICD has been revised periodically to reflect progress in medical knowledge, with later revisions generally providing greater specificity of coding.

Crosswalk of ICD-10 codes to ICD-9 codes and ICDA-8 codes
ICD-10	ICD-9	ICDA-8
K70.0 Alcoholic fatty liver	571.0 Alcoholic fatty liver	571.0 Alcohol-related liver cirrhosis
K70.1 Alcoholic hepatitis	571.1 Acute alcoholic hepatitis
K70.2 Alcoholic fibrosis and sclerosis of liver K70.3 Alcoholic cirrhosis of liver	571.2 Alcoholic cirrhosis of liver
K70.9 Alcoholic liver disease, unspecified	571.3 Alcoholic liver damage, unspecified
K70.4 Alcoholic hepatic failure
K73.0 Chronic persistent hepatitis, not elsewhere classified (n.e.c.) K73.1 Chronic lobular hepatitis, n.e.c. K73.2 Chronic active hepatitis, n.e.c. K73.8 Other chronic hepatitis, n.e.c. K73.9 Chronic hepatitis, unspecified	571.4 Chronic hepatitis	571.8 Specified liver cirrhosis without mention of alcohol
K74.3 Primary biliary cirrhosis K74.4 Secondary biliary cirrhosis K74.5 Biliary cirrhosis, unspecified	571.6 Biliary cirrhosis
K76.0 Fatty (change of) liver, n.e.c.¹	571.8 Other chronic nonalcoholic liver disease
K76.6 Portal hypertension¹	572.3 Portal hypertension
K74.0 Hepatic fibrosis K74.2 Hepatic fibrosis with hepatic sclerosis K74.6 Other and unspecified cirrhosis of liver	571.5 Cirrhosis of the liver without mention of alcohol	571.9 Unspecified liver cirrhosis without mention of alcohol
K74.1 Hepatic sclerosis	571.9 Unspecified liver cirrhosis without mention of alcohol

¹Not defined as liver cirrhosis by NCHS.

The eighth (NCHS 1968), ninth (World Health Organization [WHO] 1978), and tenth (WHO 1992) revisions of the ICD (ICDA-8, ICD-9, and ICD-10, implemented in 1968, 1979, and 1999, respectively) provide for coding categories of cirrhosis with and without mention of alcohol. ICD-9 uses different categories for cirrhosis than ICDA-8. ICD-10 uses twice as many categories for cirrhosis as does ICD-9. To examine trends for comparable diseases over time, ICD-9 and ICD-10 categories must be matched and recoded to those consistent with ICDA-8 categories. The relevant crosswalk of the three ICD revisions, developed by AEDS staff in collaboration with NIAAA’s former Division of Biometry and Epidemiology (DBE), is shown in the table “Crosswalk of ICD-10 codes to ICD-9 codes and ICDA-8 codes.” As the ICD-10 column shows, this report includes portal hypertension (ICD code K76.6) and fatty (change of) liver not elsewhere classified (n.e.c.) (ICD code K76.0) among cirrhosis categories. Because NCHS counts only ICD codes K70, K73, and K74 as liver cirrhosis, numbers presented in this report are slightly larger than those reported by NCHS.

Race and Hispanic Origin of Decedent

Data presented in this report include White and Black race categories. Other races such as American Indian/Alaska Native and Asian/Pacific Islander are not shown separately but are subsumed within the “all races” category. In compliance with the “Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity” (Office of Management and Budget 1997), the 2003 revision of the U.S. Standard Certificate of Death introduced the option to report more than one race, or multiple races. Initially, only seven states (California, Hawaii, Idaho, Maine, Montana, New York, and Wisconsin) adopted this in 2003. However, by 2018, all states and the District of Columbia had begun reporting multiple races on death certificates (Xu et al. 2021). From 2003 to 2020, the National Center for Health Statistics ‘bridged’ multiple races to a single race. This was done to ensure uniformity over time and comparability between death certificates and population estimates. During this process, a single race was assigned to multiracial decedents based on the combination of races, Hispanic origin, sex, and age indicated on their death certificates (Weed 2004). However, with the completion of the transition to collecting multiple-race data in 2018, NCHS discontinued the practice of bridging races on mortality data from 2021 onwards. For trend analysis by race, a break in the data series occurs in 2020 due to this methodological shift. That year marks the transition from bridged-race estimates to single-race estimates, which are introduced for the first time in this report.

Vital statistics data also provide information on the Hispanic origin (also known as ethnicity) of decedents. From 2000 through 2023, the percentage of cirrhosis deaths with unknown Hispanic origin was less than 1 percent for both Black and White decedents. In 2023, only 0.3 percent of cirrhosis decedents had an “unknown” classification for Hispanic origin. The tables and figures showing data based on Hispanic origin excluded decedents for whom Hispanic origin could not be determined. Readers are cautioned that rates calculated for Black Hispanics are unreliable because of the small number of cirrhosis deaths in this population subgroup.

After continuous, rapid population growth over the past few decades, Hispanics became the largest minority group in the United States in 2001 (U.S. Census Bureau 2011). Although Hispanics often are considered one ethnic group, they are well known for heterogeneity by country of origin in terms of socioeconomic status and drinking patterns, which may well affect cirrhosis mortality. To provide information on Hispanic subgroup differences, this report presents additional data on cirrhosis mortality rates for four major Hispanic subgroups: Mexican-origin, Puerto Rican-origin, Cuban-origin, and Other Hispanics.

Mortality Measures

For epidemiologic purposes, mortality rates are used to compare the frequency of death from a disease or condition. The following measures are used in this report to assess trends in liver cirrhosis mortality:

Unadjusted (or crude) death rates—These are summary measures calculated by dividing the total number of deaths from cirrhosis (or subcategories) in the population in a certain year by the total number of individuals in that population in that year (i.e., population at risk). Problems can arise when comparing crude rates between various years to assess any change in mortality over time because the populations at risk may differ with respect to an underlying characteristic such as age, race, or sex. For example, an older population tends to have a higher rate of death for a target disease than a younger population because death from disease is more common in an aging population. In this case, rates in different populations should be assessed by comparing age-specific rates and age-adjusted rates.
Age-specific death rates—These rates for any year refer to the number of deaths from liver cirrhosis (or subcategories) in a defined age interval, divided by the total number of persons in that age interval. For a given age interval, examining age-specific rates for various years allows comparison of mortality rates among subgroups of the population that do not differ in their age distribution. Age-specific rates also provide a basis for detailed study of the variation of mortality rates among different age intervals in any single year.
Age-adjusted death rates—These are statistically constructed summary rates that account for differences in mortality, regardless of any difference in the age distribution between populations. Age adjustment assumes that populations have the same age distribution and applies a standard age distribution to the calculation of age-adjusted rates for various populations. Therefore, when comparing age-adjusted rates of two populations, any differences between the rates can no longer be attributed to the difference in the age distribution between the two populations. Age adjustment is crucial for standardizing rates over many years because the U.S. population has grown progressively older in recent decades. Without age adjustment, any apparent increases in unadjusted mortality rates for cirrhosis (or any other disease) could be due to the fact that older people are more likely to die from disease.

According to the HHS requirement (1998), this report applies the year 2000 standard population to the calculation of all age-adjusted death rates (replacing the 1940 standard population used in issues published before 2002).¹

¹ Standard population age distribution:

	Number
Age group	1940	2000
0 to 24 years	432,093	97,039,882
25 to 34 years	162,066	37,233,437
35 to 44 years	139,237	44,659,185
45 to 54 years	117,811	37,030,152
55 to 64 years	80,294	23,961,506
65 to 74 years	48,426	18,135,514
75 to 84 years	17,303	12,314,793
85+ years	2,770	4,259,173
All ages	1,000,000	274,633,642
Source: Murphy (2000) for 1940 age standard; Miniño et al. (2007) for 2000 age standard.

Age-adjusted death rates presented in this report were computed by using 10-year age intervals of the enumerated population of the United States in 2000 as the standard population. Results from the age adjustment allow for meaningful comparison of similar rates over long periods of time or from different subpopulations. The basic procedure involves finding the expected number of deaths that would have existed if the age-specific rates for a particular year prevailed in a population whose age distribution was like that of the United States in 2000. This was accomplished by multiplying the specific rates for each age group by the population estimate for the corresponding age group in the standard population. The age-adjusted death rate was then calculated by adding the expected number of deaths for each age group and dividing this sum by the total population estimate taken as the standard.

Rates for Hispanic subgroups are based on 5-year annual moving averages to increase the reliability of these estimates. Readers are cautioned that the rates are subject to sampling variability of the population data (denominator) drawn from either the Current Population Survey or the American Community Survey as well as random variations of the death counts (numerator) drawn from the mortality data.

Rates for States and Census Regions are based on 3-year annual moving averages to increase the reliability of these estimates.

Limitations

There is no standard definition of liver cirrhosis deaths. This report is based on the NIAAA definition (Stinson et al. 2001), which includes more ICD codes than the NCHS definition but fewer than the WHO Global Burden of Disease definition (Mokdad et al. 2014). The NIAAA definition does not include those deaths with an underlying cause of viral hepatitis, other liver diseases, and some other complications of liver diseases. Death numbers and the corresponding mortality trends over time can differ when estimated using different definitions (Asrani et al. 2013; Manos et al. 2008; Vong and Bell 2004).

The introduction of ICD-10 for 1999 data brought changes in rules for selecting the underlying cause of death and new categories. These new rules and categories may contribute to observed changes in the number of deaths from liver cirrhosis. Anderson and colleagues (2001) conducted a comparability study that estimated that the use of ICD-10 would classify an additional 3.67 percent of deaths as due to cirrhosis when compared with ICD-9. Readers should keep this in mind when examining trends involving data from 1999 and later years. In addition, NCHS implemented coding changes in 2007 that resulted in more deaths being assigned to alcoholic liver disease (ICD-10 code K70). Therefore, the unusually big increase in cirrhosis deaths observed from 2006 to 2007 may be largely due to these coding changes (Xu et al. 2010).

List of Tables

See the PDF for full tables

Table 1. Age-adjusted death rates from liver cirrhosis by sex (death registration States, 1910–1932, and United States, 1933–2023).

Table 2. Age-specific number of deaths, age-specific death rates, and age-adjusted death rates from all liver cirrhosis by race, Hispanic origin, and sex, United States, 2000–2023.

Table 3. Age-specific number of deaths, age-specific death rates, and age-adjusted death rates from liver cirrhosis with and without mention of alcohol by sex, United States, 2000–2023.

Table 4. Age-adjusted death rates from liver cirrhosis with and without mention of alcohol by sex, race, and Hispanic origin, United States, 2000–2023.

Table 5. Age-specific number of deaths, 5-year annual moving average of age-specific death rates, and age-adjusted death rates from all liver cirrhosis by Hispanic subgroup and sex, United States, 2000–2023.

Table 6. Age-specific number of deaths, 5-year annual moving average of age-specific death rates, and age-adjusted death rates from liver cirrhosis with and without mention of alcohol by Hispanic subgroup and sex, United States, 2000–2023.

Table 7. Number of deaths and 3-year annual moving average of age-adjusted death rates from liver cirrhosis with and without mention of alcohol, States, Census Regions, and the United States, 2000–2023.

Appendix A. Data sources of population estimates at the national and State levels and for Hispanic subgroups.

Figures

Figure 1. Age-adjusted death rates from liver cirrhosis by sex (death registration States, 1910–1932, and United States, 1933–2023)

Figure 2. Age-specific death rates from liver cirrhosis, United States, 2000–2023.

Figure 3. Age-specific death rates from liver cirrhosis by race and sex, United States, 2000–2023.
Note: Different age groups may have different scales.

Figure 4. Age-adjusted death rates from liver cirrhosis by sex, race, and Hispanic origin, United States, 2000–2023.

Figure 5. Age-adjusted death rates from liver cirrhosis reported with and without mention of alcohol, United States, 2000–2023.

Figure 6. Percentage of all cirrhosis deaths coded as alcohol related by age, United States, 2000–2023.

Figure 7. Percentage of all cirrhosis deaths coded as alcohol related by sex and age, United States, 2000–2023.

Figure 8. Age-specific death rates from alcohol-related liver cirrhosis by sex, United States, 2000–2023.
Note: Different age groups may have different scales.

Figure 9. Age-adjusted death rates from alcohol-related liver cirrhosis by sex, race, and Hispanic origin, United States, 2000–2023.

Figure 10. Age-adjusted death rates from specified liver cirrhosis without mention of alcohol by sex, race, and Hispanic origin, United States, 2000–2023.

Figure 11. Age-adjusted death rates from unspecified liver cirrhosis without mention of alcohol by sex, race, and Hispanic origin, United States, 2000–2023.

Figure 12. Five-year annual average of age-adjusted death rates from liver cirrhosis with and without mention of alcohol by Hispanic subgroup and sex, United States, 2019–2023.

Figure 13. Three-year annual average of age-adjusted death rates from all liver cirrhosis by State, 2021–2023.

Figure 14. Three-year annual average of age-adjusted death rates from alcohol-related liver cirrhosis by State, 2021–2023.

Figure 15. Three-year annual average of age-adjusted death rates from all other liver cirrhosis without mention of alcohol by State, 2021–2023.

References

Anouti, A.; Kerr, T.A.; Mitchell, M.C.; and Cotter, T.G. Advances in the management of alcohol-associated liver disease. Gastroenterology Report 12, goae097, 2024.

Anderson, R.N.; Miniño, A.M.; Hoyert, D.L.; and Rosenberg, H.M. Comparability of Cause of Death between ICD-9 and ICD-10: Preliminary Estimates. National Vital Statistics Reports, Vol. 49, No. 2. Hyattsville, MD: National Center for Health Statistics, 2001.

Arias, E.; Anderson, R.N.; Kung, H.C.; Murphy, S.L.; and Kochanek, K.D. Deaths: Final Data for 2001. National Vital Statistics Reports, Vol. 52, No. 3. Hyattsville, MD: National Center for Health Statistics, 2003.

Asrani, S.K.; Larson, J.J.; Yawn, B.; Therneau, T.M.; and Kim, W.R. Underestimation of liver-related mortality in the United States. Gastroenterology 145(2):375–382, 2013.

Bajaj, J.S.; Kamath, P.S.; and Reddy, K.R. The evolving challenge of infections in cirrhosis. New England Journal of Medicine 384(24):2317–2330, 2021.

Bureau of the Census. Mortality Statistics (Data for Years 1920–1936). Washington, DC: Department of Commerce, 1922–1938. Available at: https://www.cdc.gov/nchs/products/vsus.htm . Accessed May 15, 2024.

Bureau of the Census. Vital Statistics of the United States (Data for Years 1937–1944). Washington, DC: Department of Commerce, 1939–1946. Available at: https://www.cdc.gov/nchs/products/vsus.htm . Accessed May 15, 2024.

Crabb, D.W.; Im, G.Y.; Szabo, G.; Mellinger, J.L.; and Lucey, M.R. Diagnosis and treatment of alcohol‐associated liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases. Hepatology 71:306, 2020.

Department of Health and Human Services. HHS Policy for Changing the Population Standard for Age Adjusting Death Rates. Memorandum from the Secretary. Washington, DC: DHHS, August 26, 1998. Available at: https://aspe.hhs.gov/datacncl/ageadj.htm . Accessed May 15, 2024.

Dezső, K.; Paku, S.; Kóbori, L.; Thorgeirsson, S.S.; and Nagy, P. What makes cirrhosis irreversible?—consideration on structural changes. Frontiers in Medicine 9:876293, 2022.

Ding, C.; Ng Fat, L.; Britton, A.; Im, P.K.; Lin, K.; Topiwala, A.; Li, L.; Chen, Z.; Millwood, I.Y.; Bell, S.; and Mehta, G. Binge-pattern alcohol consumption and genetic risk as determinants of alcohol-related liver disease. Nature Communications 14(1):8041, 2023.

Ginès, P.; Castera, L.; Lammert, F.; Graupera, I.; Serra-Burriel, M.; Allen, A.M.; Wong, V.W.-S.; Hartmann, P.; Thiele, M.; Caballeria, L.; de Knegt, R.J.; Grgurevic, I.; Augustin, S.; Tsochatzis, E.A.; Schattenberg, J.M.; Guha, I.N.; Martini, A.; Morillas, R.M.; Garcia-Retortillo, M.; de Koning, H.J.; Fabrellas, N.; Pich, J.; Ma, A.T.; Diaz, M.A.; Roulot, D.; Newsome, P.N.; Manns, M.; Kamath, P.S.; Krag, A.; and LiverScreen Consortium Investigators. Population screening for liver fibrosis: Towards early diagnosis and intervention for chronic liver diseases. Hepatology 75(1):219, 2022.

Goldberg, E.; and Chopra, S. Cirrhosis in adults: Etiologies, clinical manifestations, and diagnosis. In: UpToDate, Post, T.W. (ed.), Waltham, MA: UpToDate, 2024a.

Goldberg, E.; and Chopra, S. Cirrhosis in adults: Overview of complications, general management, and prognosis. In: UpToDate, Post, T.W. (ed.), Waltham, MA: UpToDate, 2024b.

Grove, R.D.; and Hetzel, A.M. Vital Statistics Rates in the United States, 1940–1960. Public Health Service Publication No. 1677. Washington, DC: Department of Health, Education, and Welfare, Public Health Service, National Center for Health Statistics, 1968.

Haberman, P.W.; and Weinbaum, D.F. Liver cirrhosis with and without mention of alcohol as cause of death. British Journal of Addiction 85(2):217–222, 1990.

Haque, L.Y.; Zuluaga, P.; Muga, R.; and Fuster, D. Treatment of alcohol use disorder in patients with alcohol-associated liver disease: Innovative approaches and a call to action. Addiction Science & Clinical Practice 19:19, 2024.

Hernández-Évole, H.; Jiménez-Esquivel, N.; Pose, E.; and Bataller, R. Alcohol-associated liver disease: Epidemiology and management. Annals of Hepatology 29:101162, 2024.

Heron, M.; Hoyert, D.L.; Murphy, S.L.; Xu, J.; Kochanek, K.D.; and Tejada-Vera, B. Deaths: Final Data for 2006. National Vital Statistics Reports, Vol. 57, No. 14. Hyattsville, MD: National Center for Health Statistics, 2009.

Hoyert, D.L.; Heron, M.P.; Murphy, S.L.; and Kung, H.C. Deaths: Final Data for 2003. National Vital Statistics Reports, Vol. 54, No. 13. Hyattsville, MD: National Center for Health Statistics, 2006.

Huang, D.Q.; Mathurin, P.; Cortez-Pinto, H.; and Loomba, R. Global epidemiology of alcohol-associated cirrhosis and HCC: Trends, projections and risk factors. Nature Reviews Gastroenterology & Hepatology 20:37–49, 2023a.

Huang, D.Q.; Terrault, N.A.; Tacke, F.; Gluud, L.L.; Arrese, M.; Bugianesi, E.; and Loomba, R. Global epidemiology of cirrhosis—aetiology, trends and predictions. Nature Reviews Gastroenterology & Hepatology 20:388–398, 2023b.

Jain, P.; and Saxena, P. Machine learning based liver cirrhosis detection using different algorithm: A review. International Journal of Scientific Research in Science and Technology 11:69–78, 2024.

Jones, P.D.; Lai, J.C.; Bajaj, J.S.; and Kanwal, F. Actionable solutions to achieve health equity in chronic liver disease. Clinical Gastroenterology and Hepatology 21:1992–2000, 2023.

Kardashian, A.; Serper, M.; Terrault, N.; and Nephew, L.D. Health disparities in chronic liver disease. Hepatology 77:1382, 2023.

Kezer, C.A.; Simonetto, D.A.; and Shah, V.H. Sex differences in alcohol consumption and alcohol-associated liver disease. Mayo Clinic Proceedings 96: 1006–1016, 2021.

Kim, D.; Li, A.A.; Gadiparthi, C.; Khan, M.A.; Cholankeril, G.; Glenn, J.S.; and Ahmed, A. Changing trends in etiology-based annual mortality from chronic liver disease, from 2007 through 2016. Gastroenterology 155(4):1154–1163, 2018.

Kochanek, K.D.; Murphy, S.L.; Anderson, R.N.; and Scott, C. Deaths: Final Data for 2002. National Vital Statistics Reports, Vol. 53, No. 5. Hyattsville, MD: National Center for Health Statistics, 2004.

Kochanek, K.D.; Murphy, S.L.; and Xu, J. Deaths: Final Data for 2011. National Vital Statistics Reports, Vol. 63, No. 3. Hyattsville, MD: National Center for Health Statistics, 2015.

Kochanek, K.D.; Murphy, S.L.; Xu, J.; and Arias, E. Deaths: Final Data for 2017. National Vital Statistics Reports, Vol. 68, No. 9. Hyattsville, MD: National Center for Health Statistics, 2019.

Kochanek, K.D.; Murphy, S.L.; Xu, J.; and Tejada-Vera, B. Deaths: Final Data for 2014. National Vital Statistics Reports, Vol. 65, No. 4. Hyattsville, MD: National Center for Health Statistics, 2016.

Kochanek, K.D.; Xu, J.; Murphy, S.L.; Miniño, A.M.; and Kung, H.C. Deaths: Final Data for 2009. National Vital Statistics Reports, Vol. 60, No. 3. Hyattsville, MD: National Center for Health Statistics, 2011.

Kung, H.C.; Hoyert, D.L.; Xu, J.; and Murphy, S.L. Deaths: Final Data for 2005. National Vital Statistics Reports, Vol. 56, No. 10. Hyattsville, MD: National Center for Health Statistics, 2008.

Kwong, A.J.; Kim, W.R.; Lake, J.R.; Schladt, D.P.; Schnellinger, E.M.; Gauntt, K.; McDermott, M.; Weiss, S.; Handarova, D.K.; Snyder, J.J.; and Israni, A.K. OPTN/SRTR 2022 Annual Data Report: Liver. American Journal of Transplantation 24:S176–S265, 2024.

Lackner, C.; Spindelboeck, W.; Haybaeck, J.; Douschan, P.; Rainer, F.; Terracciano, L.; Haas, J.; Berghold, A.; Bataller, R.; and Stauber, R.E. Histological parameters and alcohol abstinence determine long-term prognosis in patients with alcoholic liver disease. Journal of Hepatology 66:610–618, 2017.

Lee, B.P.; and Terrault, N.A. Liver-related mortality in the United States: Hepatitis C declines, non-alcoholic fatty liver and alcohol rise. Translational Gastroenterology and Hepatology 4:19, 2019.

Linder, F.E.; and Grove, R.D. Vital Statistics Rates in the United States: 1900–1940. Washington, DC: Department of Commerce, Bureau of the Census, 1943.

Llamosas-Falcón, L.; Probst, C.; Buckley, C.; Jiang, H.; Lasserre, A.M.; Puka, K.; Tran, A.; Zhu, Y.; and Rehm, J. How does alcohol use impact morbidity and mortality of liver cirrhosis? A systematic review and dose–response meta-analysis. Hepatology International 18(1):216–224, 2024.

Llamosas-Falcón, L.; Probst, C.; Buckley, C.; Jiang, H.; Lasserre, A.M.; Puka, K.; Tran, A.; and Rehm, J. Sex-specific association between alcohol consumption and liver cirrhosis: An updated systematic review and meta-analysis. Frontiers in Gastroenterology (Lausanne) 1:1005729, 2022.

Mackowiak, B.; Fu, Y.; Maccioni, L.; and Gao, B. Alcohol-associated liver disease. The Journal of Clinical Investigation 134(3):e176345, 2024.

Mann, R.E.; Smart, R.G.; and Govoni, R. The epidemiology of alcoholic liver disease. Alcohol Research & Health 27(3):209–219, 2003.

Manos, M.M.; Leyden, W.A.; Murphy, R.C.; Terrault, N.A.; and Bell, B.P. Limitations of conventionally derived chronic liver disease mortality rates: Results of a comprehensive assessment. Hepatology 47(4):1150–1157, 2008.

Miniño, A.M.; Arias, E.; Kochanek, K.D.; Murphy, S.L.; and Smith, B.L. Deaths: Final Data for 2000. National Vital Statistics Reports, Vol. 50, No. 15. Hyattsville, MD: National Center for Health Statistics, 2002.

Miniño, A.M.; Heron, M.P.; Murphy, S.L.; and Kochanek, K.D. Deaths: Final Data for 2004. National Vital Statistics Reports, Vol. 55, No. 19. Hyattsville, MD: National Center for Health Statistics, 2007.

Miniño, A.M.; Murphy, S.L.; Xu, J.; and Kochanek, K.D. Deaths: Final Data for 2008. National Vital Statistics Reports, Vol. 59, No. 10. Hyattsville, MD: National Center for Health Statistics, 2011.

Mokdad, A.A.; Lopez, A.D.; Shahraz, S.; Lozano, R.; Mokdad, A.H.; Stanaway, J.; Murray, C.J.; and Naghavi, M. Liver cirrhosis mortality in 187 countries between 1980 and 2010: A systematic analysis. BMC Medicine 12:145, 2014.

Murphy, S.L. Deaths: Final Data for 1998. National Vital Statistics Reports, Vol. 48, No. 11. Hyattsville, MD: National Center for Health Statistics, 2000.

Murphy, S.L.; Kochanek, K.D.; Xu, J.; and Heron, M. Deaths: Final Data for 2012. National Vital Statistics Reports, Vol. 63, No. 9. Hyattsville, MD: National Center for Health Statistics, 2015.

Murphy, S.L.; Xu, J.; and Kochanek, K.D. Deaths: Final Data for 2010. National Vital Statistics Reports, Vol. 61, No. 4. Hyattsville, MD: National Center for Health Statistics, 2013.

Murphy, S.L.; Xu, J.; Kochanek, K.D.; Arias, E.; and Tejada-Vera, B. Deaths: Final Data for 2018. National Vital Statistics Reports, Vol. 69, No. 13. Hyattsville, MD: National Center for Health Statistics, 2021.

Murphy, S.L.; Xu, J.; Kochanek, K.D.; Curtin, S.C.; and Arias, E. Deaths: Final Data for 2015. National Vital Statistics Reports, Vol. 66, No. 6. Hyattsville, MD: National Center for Health Statistics, 2017.

National Cancer Institute. U.S. Population Data. Bethesda, MD: NCI, 2002. Available at: http://seer.cancer.gov/popdata/download.html . Accessed May 15, 2024.

National Center for Health Statistics. Vital Statistics of the United States (Data for Years 1959–1969). Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, 1961–1974. Available at: https://www.cdc.gov/nchs/products/vsus.htm . Accessed May 15, 2024.

National Center for Health Statistics. Eighth Revision, International Classification of Diseases Adapted for Use in the United States. DHEW Pub. No. PHS 1693. Washington, DC: U.S. Department of Health, Education, and Welfare, 1968.

National Center for Health Statistics. Instructions for Classifying the Underlying Cause of Death, 1983. Hyattsville, MD: National Center for Health Statistics, September 1982.

National Center for Health Statistics. Bridged-race Intercensal Estimates of the July 1, 1990–July 1, 1999, United States Resident Population by State, County, Age Group, Sex, Race, and Hispanic Origin. Washington, DC: U.S. Census Bureau and National Cancer Institute, April 15, 2003. Available at: https://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm . Accessed May 15, 2024.

National Center for Health Statistics. Intercensal Estimates of the Resident Population of the United States for July 1, 2000–July 1, 2009, by Year, County, Single-year of Age (0, 1, 2, . . . , 85 Years and Over), Bridged Race, Hispanic Origin, and Sex. Washington, DC: NCHS and U.S. Census Bureau, October 26, 2012. Available at: https://www.cdc.gov/nchs/nvss/bridged_race.htm . Accessed May 15, 2024.

National Center for Health Statistics. Vintage 2020 Postcensal Estimates of the Resident Population of the United States (April 1, 2010, July 1, 2010–July 1, 2020), by Year, County, Single-year of Age (0, 1, 2, . . ., 85 years and over), Bridged Race, Hispanic Origin, and Sex. Washington, DC: NCHS and U.S. Census Bureau, September 22, 2021. Available at https://www.cdc.gov/nchs/nvss/bridged_race.htm . Accessed May 15, 2024.

National Office of Vital Statistics. Vital Statistics of the United States (Data for Years 1945–1949). Washington, DC: Federal Security Agency, United States Public Health Service, 1947–1951. Available at: https://www.cdc.gov/nchs/products/vsus.htm . Accessed May 15, 2024.

National Office of Vital Statistics. Vital Statistics of the United States (Data for Years 1950–1958). Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, 1953–1960. Available at: https://www.cdc.gov/nchs/products/vsus.htm . Accessed May 15, 2024.

National Office of Vital Statistics. Death Rates by Age, Race, and Sex, United States, 1900–1953: Cirrhosis of Liver. Vital Statistics—Special Reports. Vol. 43, No. 24. Washington, DC: U.S. Department of Health, Education, and Welfare, Public Health Service, 1956.

Office of Management and Budget. Revisions to the standards for the classification of federal data on race and ethnicity. Federal Register 62 (210): 58782–58790, 1997. Available at: https://www.whitehouse.gov/wp-content/uploads/2017/11/Revisions-to-the-Standards-for-the-Classification-of-Federal-Data-on-Race-and-Ethnicity-October30-1997.pdf . Accessed May 15, 2024.

Osna, N.A.; Donohue, T.M.; and Kharbanda, K.K. Alcoholic liver disease: Pathogenesis and current management. Alcohol Research: Current Reviews 38: 147–161, 2017.

Pageaux, G.-P.; Nzinga, C.L.; Ganne, N.; Samuel, D.; Dorival, C.; Zoulim, F.; Cagnot, C.; Decaens, T.; Thabut, D.; Asselah, T.; Mathurin, P.; Habersetzer, F.; Bronowicki, J.-P.; Guyader, D.; Rosa, I.; Leroy, V.; Chazouilleres, O.; de Ledinghen, V.; Bourliere, M.; Causse, X.; Cales, P.; Metivier, S.; Loustaud-Ratti, V.; Riachi, G.; Alric, L.; Gelu-Simeon, M.; Minello, A.; Gournay, J.; Geist, C.; Tran, A.; Abergel, A.; Portal, I.; d’Alteroche, L.; Raffi, F.; Fontaine, H.; Carrat, F.; Pol, S.; and French ANRS CO22 Hepather Cohort. Clinical outcomes after treatment with direct antiviral agents: Beyond the virological response in patients with previous HCV-related decompensated cirrhosis. BMC Infectious Diseases 22:94, 2022.

Park, S.H.; Lee, Y.-S.; Sim, J.; Seo, S.; and Seo, W. Alcoholic liver disease: A new insight into the pathogenesis of liver disease. Archives of Pharmacal Research 45:447–459, 2022.

Piano, S.; Bunchorntavakul, C.; Marciano, S.; and Rajender Reddy, K. Infections in cirrhosis. The Lancet Gastroenterology & Hepatology S2468–1253(24):00078–5, 2024.

Powell, W.J.; and Klatskin, G. Duration of survival in patients with Laennec’s cirrhosis: Influence of alcohol withdrawal, and possible effects of recent changes in general management of the disease. American Journal of Medicine 44(3):406–420, 1968.

Premkumar, M., and Anand, A.C. Overview of complications in cirrhosis. Journal of Clinical and Experimental Hepatology 12:1150–1174, 2022.

Puffer, R.R.; and Griffith, G.W. Patterns of Urban Mortality: Report of the Inter-American Investigation of Mortality. Washington, DC: Pan American Health Organization, 1967.

Ramstedt, M. Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol—The case of Canada. Addiction 98(9):1267–1276, 2003.

Rehm, J.; and Shield, K.D. Global burden of alcohol use disorders and alcohol liver disease. Biomedicines 7: 99, 2019.

Roerecke, M.; Vafaei, A.; Hasan, O.S.; Chrystoja, B.R.; Cruz, M.; Lee, R.; Neuman, M.G.; and Rehm, J. Alcohol consumption and risk of liver cirrhosis: A systematic review and meta-analysis. The American Journal of Gastroenterology 114:1574–1586, 2019.

Scaglione, S.; Kliethermes, S.; Cao, G.; Shoham, D.; Durazo, R.; Luke, A.; and Volk, M.L. The epidemiology of cirrhosis in the United States: A population-based study. Journal of Clinical Gastroenterology 49(8):690–696, 2015.

Shah, N.D.; Ventura-Cots, M.; Abraldes, J.G.; Alboraie, M.; Alfadhli, A.; Argemi, J.; Badia-Aranda, E.; Arús-Soler, E.; Barritt, A.S.; Bessone, F.; Biryukova, M.; Carrilho, F.J.; Fernández, M.C.; Guiridi, Z.D.; Kassas, M.E.; Eng-Kiong, T.; Farias, A.Q.; George, J.; Gui, W.; Thurairajah, P.H.; Hsiang, J.C.; Husić-Selimovic, A.; Isakov, V.; Karoney, M.; Kim, W.; Kluwe, J.; Kochhar, R.; Dhaka, N.; Costa, P.M.; Pharm, M.A.N.; Ono, S.K.; Reis, D.; Rodil, A.; Domech, C.R.; Sáez-Royuela, F.; Scheurich, C.; Siow, W.; Sivac-Burina, N.; Traquino, E.S.D.S.; Some, F.; Spreckic, S.; Tan, S.; Vorobioff, J.; Wandera, A.; Wu, P.; Yacoub, M.; Yang, L.; Yu, Y.; Zahiragic, N.; Zhang, C.; Cortez-Pinto, H.; and Bataller, R. Alcohol-related liver disease is rarely detected at early stages compared with liver diseases of other etiologies worldwide. Clinical Gastroenterology and Hepatology 17: 2320–2329.e12, 2019.

Singal, A.K.; Leggio, L.; and DiMartini, A. Alcohol use disorder in alcohol-associated liver disease: Two sides of the same coin. Liver Transplantation 30:200, 2024.

Singh, S.; Osna, N.A.; and Kharbanda, K.K. Treatment options for alcoholic and non-alcoholic fatty liver disease: A review. World Journal of Gastroenterology 23(36):6549–6570, 2017.

Stein, E.; Cruz-Lemini, M.; Altamirano, J.; Ndugga, N.; Couper, D.; Abraldes, J.G.; and Bataller, R. Heavy daily alcohol intake at the population level predicts the weight of alcohol in cirrhosis burden worldwide. Journal of Hepatology pii:S0168–8278(16):30307–30315, 2016.

Stinson, F.S.; Grant, B.F.; and Dufour, M.C. The critical dimension of ethnicity in liver cirrhosis mortality statistics. Alcoholism: Clinical and Experimental Research 25(8):1181–1187, 2001.

Szabo, G.; and Mandrekar, P. Focus on: Alcohol and the liver. Alcohol Research & Health 33(1–2):87–96, 2010.

Tapper, E.B.; and Parikh, N.D. Diagnosis and management of cirrhosis and its complications: A review. JAMA 329:1589–1602, 2023.

U.S. Bureau of the Census. Estimates of the Population of the United States, by Age, Sex and Race: April 1, 1960 to July 1, 1973. Current Population Reports Series, P-25, No. 519. Washington, DC: Department of Commerce, 1974.

U.S. Census Bureau. Table 2. Intercensal Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 1, 2000, to July 1, 2010 (US-EST00INT-02). Washington, DC: U.S. Census Bureau, September 2011. Available at: https://www.census.gov/data/tables/time-series/demo/popest/intercensal-2000-2010-national.html . Accessed May 15, 2024.

U.S. Census Bureau. 2000–2023 American Community Survey 1-year Public Use Microdata Samples. Washington, DC: U.S. Census Bureau, 2024a. Available at: https://www2.census.gov/programs-surveys/acs/data/pums/ . Accessed January 16, 2025.

U.S. Census Bureau. Annual State Resident Population Estimates for 6 Race Groups (5 Race Alone Groups and Two or More Races) by Age, Sex, and Hispanic Origin: April 1, 2020 to July 1, 2023. Washington, DC: U.S. Census Bureau, 2024b. Available at: https://www2.census.gov/programs-surveys/popest/datasets/2020-2023/state/asrh/sc-est2023-alldata6.csv . Accessed January 16, 2025.

U.S. Department of Health and Human Services. Healthy People 2030—Drug and Alcohol Use. Washington, DC: Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, n.d. Available at: https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/drug-and-alcohol-use . Accessed May 15, 2024.

Vong, S.; and Bell, B.P. Chronic liver disease mortality in the United States, 1990–1998. Hepatology 39(2):476–483, 2004.

Wahlang, B.; Beier, J.I.; Clair, H.B.; Bellis-Jones, H.J.; Falkner, K.C.; McClain, C.J.; and Cave, M.C. Toxicant-associated steatohepatitis. Toxicologic Pathology 41(2):343–360, 2013.

Weed, J.A. NCHS procedures for multiple-race and Hispanic origin data: Collection, coding, editing, and transmitting. In: 2004 Joint Meeting of NAPHSIS and VSCP. Portland, Oregon. June 6–10, 2004. Available at: https://www.cdc.gov/nchs/data/dvs/Multiple_race_docu_5-10-04.pdf . Accessed May 15, 2024.

World Health Organization. International Classification of Diseases, 9th Revision. Geneva, Switzerland: WHO, 1978.

World Health Organization. International Classification of Diseases and Related Health Problems, Tenth Revision. Geneva, Switzerland: WHO, 1992.

Xie, Y.-D.; Feng, B.; Gao, Y.; and Wei, L. Effect of abstinence from alcohol on survival of patients with alcoholic cirrhosis: A systematic review and meta-analysis. Hepatology Research: The Official Journal of the Japan Society of Hepatology 44(4): 436–449, 2014.

Xu, J.; Kochanek, K.D.; Murphy, S.L.; and Tejada-Vera, B. Deaths: Final Data for 2007. National Vital Statistics Reports, Vol. 58, No. 19. Hyattsville, MD: National Center for Health Statistics, 2010.

Xu, J.; Murphy, S.L.; Kochanek, K.D.; and Bastian, B.A. Deaths: Final Data for 2013. National Vital Statistics Reports, Vol. 64, No. 2. Hyattsville, MD: National Center for Health Statistics, 2016.

Xu, J.; Murphy, S.L.; Kochanek, K.D.; Bastian, B.; and Arias, E. Deaths: Final Data for 2016. National Vital Statistics Reports, Vol. 67, No. 5. Hyattsville, MD: National Center for Health Statistics, 2018.

Xu, J.; Murphy, S.L.; Kochanek, K.D.; and Arias, E. Deaths: Final Data for 2019. National Vital Statistics Reports, Vol. 70, No. 8. Hyattsville, MD: National Center for Health Statistics, 2021.

Zakhari, S. Bermuda Triangle for the liver: Alcohol, obesity, and viral hepatitis. Journal of Gastroenterology and Hepatology 28(Suppl. 1):18–25, 2013.