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US - Pandemic Liver Disease Deaths

Age group 75-84

US Cause of Death Project

Update Date: August - 2024

Carlos Alegria, Yuri Nunes

Link to Pre-print paper: Paper Link

Other components of Liver Disease Deaths report:

----- Analysis of Liver Disease Deaths in older individuals, Ages 35-44
----- Analysis of Liver Disease Deaths for all ages, by 10-year age groups

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Summary/Abstract

In this study we investigate trends in death rates from Liver Diseases (ICD-10 codes K70-K76) in the USA using crude data from the CDC (Centers for Disease Control and Prevention). We perform a detailed examination for individuals aged 75 to 84 for the period of 2000 to 2023. In separate reports we also perform a detailed analysis for younger individuals and also provide a summary analysis for all age groups (10-year age groups).

We compare trends Liver Diseases deaths where these appear on multiple causes (MC) of death, or as the underlying cause (UC). To remove the effect of Covid-19, we also analyse trends in death rates from Liver Diseases where Covid-19-related deaths are also reported in the death certificate.

For individuals aged 75 to 84, our results show that the excess UC death rates from liver diseases (K70-K76) were 2.4% (Z-Score of 3.9) in 2020, then rose to 8.8% (Z-Score of 14.4) in 2021, 7.3% (Z-Score of 11.9) in 2022 and 11.1% (Z-Score of 18.2) in 2023. We also observe that the rises of excess MC* death rates (where COVID-19-related deaths are excluded) from liver diseases in 2020, 2021, 2022 and 2023 mirror the excess UC death rates, suggests that a common underlying factor is at play.

Trends in Death Rates from Liver Disease (ICD10 codes: K70-K76) for Ages 75-84

In this section we analyse the trend in yearly death rates from Liver Diseases for individuals aged 75 to 84 in the USA. We use the 2013-2019 trend in deaths per 100,000 (death rates) as the baseline estimate for excess death rates. Excess death rates for the 2013-2019 period are in-sample while the rates for 2020, 2021, 2022 and 2023 are out of sample computations.

Trends in MC (Multiple-Causes) and UC (Underlying-Cause) Death Rates from Liver Diseases, ages 75-84

The Figure (left) below shows the death rate per 100,000 individuals from Liver Disease deaths (ICD-10 codes K70-K76) in the US, for the 75-84 age group of both sexes, for the period of 2000 to 2023. The Figure plots death rates as underlying cause of death (UC) and reported as multiple-cause (MC) of death, as well as MC* death rates (where COVID-19-related deaths are removed from MC death counts). The Figure on the right shows the ratio of MC deahts by UC deaths.

plot_Liver7584-Fig1_1

plot_Liver7584-Fig1_2

Summary:

The Figure (left) shows that MC death rates from liver diseases for the 75-84 age group trended higher from 2000 to 2009 but then trended upwards from 2010 to 2019. From 2020 onwards we observe that both MC and UC death rates from liver disease rose substantially, with a clear break from the prior 2013-2019 trend. We also observe in Figure 5 (Right) that the ratio of MC to UC deaths trended lower from 2000 to 2019, from a value of 2.35 in 2000 to close to 2 in 2019. In 2020, 2021, 2022 and 2023 the ratio of MC* to UC deaths rose quickly, which means that MC* deaths from liver disease increased at a higher rate than UC deaths. It should be noted that MC and MC* (except COVID-19) death rates were the same from 2000 to 2019 as COVID-19 deaths only started in 2020.

The MC death rate was 99.81 per 100,000 in 2019 and then rose in 2020 to 107.56 per 100,000, and then to 118.46 per 100,000 in 2021, to 119.23 per 100,000 in 2022 and to 124.19 per 100,000 in 2023.

After removing COVID-19-related deaths, the MC* death rate rose in 2020 to 102.41 per 100,000, and then rose again to 111.70 per 100,000 in 2021, to 112.95 per 100,000 in 2022 and in 2023 it rose again to 121.95 per 100,000. Even after removing COVID-19 related deaths, we observe an increase in MC* liver deaths in 2020, 2021, 2022 and 2023.

As for UC death rates, from a value of 48.58 per 100,000 in 2019, they rose to 50.57 per 100,000 in 2020, and then to 54.56 per 100,000 in 2021, to 54.64 per 100,000 in 2022 and to 57.43 per 100,000 in 2023.

Excess Death Rates from Liver Disease for Ages 75-84, Both Sexes.

In this section we investigate excess death rates from Liver Diseases in the US, for the 75 to 84 age group from 2010 to 2023. The figure on the left refers to relative deviations from the 2013-2019 trend, while the figure on the right shows the Z-score (signal strength) for the deviations from trend.

Excess UC Death Rates from Liver Disease, 75-84

The Figure below shows the excess death rate from liver diseases in the US (icd10 codes: K70-K76), for the 75 to 84 age group from 2010 to 2023. The plots also show the excess all-cause deaths for comparison. The figure on the left refers to relative deviations from the 2013-2019 trend, while the Figure on the right shows the Z-score (signal strength) for the deviations from trend.

plot_Liver7584-Fig2_1

plot_Liver7584-Fig2_2

Summary:

In the left Figure we can observe that the excess death rates from liver diseases as the underlying cause (UC) were 2.4% (Z-Score of 3.9) in 2020, then rose to 8.8% (Z-Score of 14.4) in 2021, 7.3% (Z-Score of 11.9) in 2022 and 11.1% (Z-Score of 18.2) in 2023. By comparison, the excess mortality for all-cause deaths was 16.8% in 2020, 21.1% in 2021, 12.8% in 2022, and 10.5% in 2023.

It is noteworthy that while excess all-cause mortality peaked in 2021 and then dropped in 2022 and 2023, excess deaths from liver diseases as the underlying cause rose consecutively in 2021, 2022 and 2023. Additionally, while excess all-cause deaths suffered an extreme rise of 16.8% in 2020, excess death rates from liver diseases were subdued at 2.4%.

Excess MC Death Rates from Liver Disease, ages 75-84

We now analyse excess MC deaths rates and excess MC* death rates (by excluding COVID-19 related deaths) from liver diseases (icd10 codes: K70-K76), for ages 75 to 84 in the US, as shown in the Figure below. The figure on the left refers to relative deviations from the 2013-2019 trend, while figure on the right shows the Z-score (signal strength) for the deviations from trend.

plot_Liver7584-Fig3_11

plot_Liver7584-Fig3_21

Summary:

In the figure (left) we can observe that the excess MC death rates from liver diseases were 6.3% (Z-Score of 8.5) in 2020, then rose to 14.8% (Z-Score of 19.8) in 2021, and to 13.3% (Z-Score of 17.8) in 2022, and 15.7% (Z-Score of 21.1) in 2023. In terms of the statistical significance of the excess deaths, these can be considered extreme events.

By comparison, the excess MC* death rates from liver diseases where COVID-19-related deaths were removed, were 1.2% (Z-Score of 1.7) in 2020, 8.2% (Z-Score of 11.0) in 2021, 7.3% (Z-Score of 9.8) in 2022 and 13.6% (Z-Score of 18.3) in 2023. Of note is that the rise in excess mortality for MC deaths from liver diseases where COVID-19-related deaths were removed, exhibited a similar pattern to UC excess death rates from liver diseases.

We also observe that MC* death rates are about 2 times higher than UC death rates from liver diseases, as illustrated by the ratio of MC/UC death rates (see the Figure in previous section). The ratio did not vary significantly during the pandemic years, 2020, 2021, 2022 and 2023, indicating that both MC and UC death rates from liver diseases had similar rises during those years.

Conclusions

For individuals aged 75 to 84, the results plotted in show that the excess UC death rates from liver diseases (K70-K76) 2.4% (Z-Score of 3.9) in 2020, then rose to 8.8% (Z-Score of 14.4) in 2021, 7.3% (Z-Score of 11.9) in 2022 and 11.1% (Z-Score of 18.2) in 2023. By comparison, the excess mortality for all-cause deaths was 16.8% in 2020, 21.1% in 2021, 12.8% in 2022, and 10.5% in 2023.

Interestingly, for individuals aged 75-84, while excess all-cause mortality peaked in 2021 and then dropped in 2022 and 2023, excess deaths from liver diseases as the underlying cause rose consecutively in 2021, 2022 and 2023. Additionally, while excess all-cause deaths suffered an extreme rise of 16.8% in 2020, excess death rates from liver diseases were subdued at 2.4%.

Excess MC death rates from liver diseases were 6.3% (Z-Score of 8.5) in 2020, then rose to 14.8% (Z-Score of 19.8) in 2021, and to 13.3% (Z-Score of 17.8) in 2022, and 15.7% (Z-Score of 21.1) in 2023. By comparison, the excess MC* death rates from liver diseases (where COVID-19-related deaths were removed), were 1.2% (Z-Score of 1.7) in 2020, 8.2% (Z-Score of 11.0) in 2021, 7.3% (Z-Score of 9.8) in 2022 and 13.6% (Z-Score of 18.3) in 2023. Of note is that the rise in excess mortality for MC* deaths with liver diseases (where COVID-19-related deaths were removed) exhibited a similar pattern to UC excess death rates from liver diseases.

Excess death rates from liver diseases from 2020 to 2023 for older individuals, for which the 75-84 age group is case study, are driven by cirrhosis and fibrosis of liver (ICD-10 code: K74) and exhibit a different pattern of behaviour when compared to excess deaths rates from liver diseases for younger individuals.

Other components of Liver Disease Deaths report:

----- Analysis of Liver Disease Deaths in older individuals, Ages 35-44
----- Analysis of Liver Disease Deaths for all ages, by 10-year age groups