Hepatitis B Mortality Rate Trends Explained

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Washington DC, Hawaii, Oklahoma, California, Tennessee, West Virginia, Mississippi, Oregon, Washington, Louisiana, Kentucky, and New York all had HBV-related mortality rates higher than the national average.

New research explains regionally whether or not the mortality rate related to hepatitis B virus (HBV) infections are rising or decreasing in the last decade.

A team, led by Kathleen N. Ly, MPH, Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, identified the characteristics of decedents with hepatitis B listed deaths between 2010-2019 and compared the age-adjusted hepatitis B-listed death rates between 2010-2019 and 2000-2009.

The majority of HBV data in the US has focused on national trends, with very little attention paid to regionally statistics to identify differences in mortality rates and decedent characteristics, including birthplace.

The Study

In the cross-sectional study, the investigators used Multiple Cause of Death data from all 50 states and Washington D.C. to assess characteristics of US residents with HBV listed as the underlying cause of death or contributing cause of death on death certificates. They identified 35,280 decedents with HBV listed as the cause of death. This included 17,483 deaths between 2010-2019.

The decedents used in the study were mostly US-born (63.3%), while 25.8% of decedents were Asian or Pacific Islander and 46.5% of decedents were White; 28.4% of decedents were listed as having hepatitis C virus (HCV) or HIV coinfection.

The investigators sought main outcomes of hepatitis B-listed death counts, age-adjusted rates, and characteristics of decedents between 2000-2019. They also examinedthe distribution of HBV deaths based on sociodemographic cTrendsharacteristics and underlying causes of death among both US and non-US born decedents.


The results show state-level rates surpassed the overall US rate of 0.47 deaths per 100,000 individuals in several areas, including Washington DC (1.78 deaths per 100 000 population), Hawaii, Oklahoma, California, Tennessee, West Virginia, Mississippi, Oregon, Washington, Louisiana, Kentucky, and New York (0.61 deaths per 100 000 population).

The team also found certain states had trends regarding age of HBV-listed deaths. For example, the deaths skewed younger in Kentucky (54.0; 95% CI, 46.0-64.0 years), West Virginia (56.0; 95% CI, 47.0-65.0 years), Tennessee (57.0; 95% CI, 50.0-65.0 years), Mississippi (58.0; 95% CI, 50.0-65.0 years), and Ohio (59.0; 95% CI, 50.0-66.0 years) than the national median (60.0; 95% CI, 53.0-69.0 years).

In addition, the national death rate already is significantly younger than non-hepatitis B-listed deaths (77; 95% CI, 63.0-87.0 years; P < .001).

Hepatitis B as the underlying cause of death represented approximately 30% of the US and non-US born decedents with hepatitis B causes of death, with liver cancer being the most predominant underlying cause of death among non-US born decadents (37.9%).

The investigators also found that the hepatitis B-listed mortality rate significantly decreased national from 2000-2009 and 2010-2019 (-18.97%), as well as in 14 states.

However, West Virginia (change, 83.78%) and Kentucky (change, 69.44%) did see significant increase in HBV-listed mortalities.

“These findings suggest that US-born decedents constituted two-thirds of all hepatitis B–listed deaths and median age at death was youngest in Appalachian states,” the authors wrote. “Irrespective of birthplace, most decedents had liver-related UCOD; however, US-born decedents more frequently had nonliver UCOD than non-US–born decedents. In addition to addressing liver-related complications, US-born persons with chronic infection may also require diagnosis and management of multiple comorbidities.”

The study, “Regional Differences in Mortality Rates and Characteristics of Decedents With Hepatitis B Listed as a Cause of Death, United States, 2000-2019,” was published online in JAMA Network Open.