OBJECTIVES In contrast with other developed nations, life expectancy is decreasing in the United States, in part due to increasing mortality from alcohol-associated liver disease (ALD). Up-to-date estimates of ALD mortality are necessary for setting public health priorities to reverse this concerning trend. We therefore aimed to assess current (2017) estimates of ALD mortality and temporal trends from 1999 to 2017. METHODS Using national data from the Centers for Disease Control and Prevention, we analyzed stratified ALD mortality rates between 1999 and 2017. We determined the age-adjusted death rates, stratified by sex and categorized by age, race/ethnicity, urbanization, and census region. We also identified statistically significant changes in the annual rate difference (ARD), annual percentage change (APC), and average APC in ALD mortality. RESULTS In 2017, mortality from ALD was higher than any other year since 1999 with age-adjusted rates of 13.1 per 100,000 (95% confidence interval [CI] 12.9-13.3) in men and 5.6 per 100,000 (95% CI 5.4-5.7) in women. Mortality was highest among men and women who were middle aged, Native American, and from rural areas. Since 2006, ALD mortality has increased in almost every age group and race with the exception of non-Hispanic black men. Absolute increases in mortality rates have been particularly pronounced in Native American women (2005-2017 ARD 0.8, 95% CI 0.6-0.9), non-Hispanic/white men (2006-2017 ARD 0.4, 95% CI 0.3-0.4), and non-Hispanic/white women (2013-2017 ARD 0.4, 95% CI 0.3-0.5). DISCUSSION Mortality from ALD is increasing over time in most demographic groups. Increased effort is needed to develop targeted public health strategies to address high and increasing ALD mortality.

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21 世纪美国酒精相关肝病死亡率上升

目标 与其他发达国家相比，美国的预期寿命正在下降，部分原因是酒精相关性肝病 (ALD) 的死亡率增加。ALD 死亡率的最新估计对于确定公共卫生优先事项以扭转这一相关趋势是必要的。因此，我们旨在评估当前（2017 年）对 1999 年至 2017 年 ALD 死亡率和时间趋势的估计。 方法使用疾病控制和预防中心的国家数据，我们分析了 1999 年至 2017 年的分层 ALD 死亡率。我们确定了年龄-调整后的死亡率，按性别分层，按年龄、种族/民族、城市化和人口普查区域分类。我们还确定了 ALD 死亡率的年率差异 (ARD)、年百分比变化 (APC) 和平均 APC 的统计学显着变化。结果 2017 年，ALD 的死亡率高于自 1999 年以来的任何其他年份，男性的年龄调整率为 13.1/100,000（95% 置信区间 [CI] 12.9-13.3）和 5.6/100,000（95% CI 5.4-5）。在女性中。中年、美洲原住民和农村地区的男性和女性的死亡率最高。自 2006 年以来，除了非西班牙裔黑人男性之外，几乎所有年龄组和种族的 ALD 死亡率都有所增加。死亡率的绝对增加在美洲原住民女性 (2005-2017 ARD 0.8, 95% CI 0.6-0.9)、非西班牙裔/白人男性 (2006-2017 ARD 0.4, 95% CI 0.3-0.4) 和非西班牙裔/白人女性（2013-2017 ARD 0.4，95% CI 0.3-0.5）。讨论 在大多数人口群体中，ALD 的死亡率随着时间的推移而增加。