Liver Cirrhosis Is No Longer a “Black” Disease

  • Cirrhosis mortality rates have historically been higher among black than white Americans
  • A new study has found that white Americans of Hispanic origin now have a greater risk of dying from cirrhosis than do black Americans
  • Among Hispanic decedents, the largest group was of Mexican ancestry
  • Drinking patterns, socioeconomic status and cultural beliefs are all contributing factors

In 1997, liver cirrhosis was the 10th leading cause of death in the United States, responsible for approximately 25,000 deaths. The disease is most frequently associated with heavy drinking and, historically, cirrhosis mortality rates have been higher among black than white Americans. A study in the August issue of Alcoholism: Clinical & Experimental Research is the first to document that white Americans of Hispanic origin have a risk of dying from cirrhosis that actually exceeds that of black Americans and is far higher than the risk for other whites.

"We’ve been looking at liver cirrhosis mortality numbers since the 1910 data year," said Frederick S. Stinson, a survey statistician with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and lead author of the study. "However, it wasn’t until we examined the newly available death-certificate information on Hispanic origin that we made a surprising finding. White Hispanic males had the highest cirrhosis mortality rates. Among these, the largest group was of Mexican ancestry." Many of these individuals had been born outside of the U.S. and had low levels of education.

"Death certificates contain a limited amount of information about each person who dies," said Stinson. "The lower levels of education and immigrant status of many of these white Hispanic decedents suggest that they probably had lower levels of income, and may have had some difficulty reading or understanding English. This could lead to less access to health education and treatment, whether that’s treatment for an alcohol problem or access to medical care for cirrhosis treatment. Perhaps most importantly, there may also be some very, very important differences associated with alcohol consumption that are driving some of these numbers."

"Some Hispanic groups," explained Deborah A. Dawson, also a statistician with the NIAAA, "especially those of Mexican or Central American heritage, have a style of drinking that is marked by periodic consumption of extremely large quantities of alcohol. Doctors and other health care workers need to be aware of the increased risk of cirrhosis in this group in order to advise them of the risks that seem to be associated with this pattern of drinking." Dawson further explained that this pattern of drinking - which seems to increase the risk of liver damage - is somewhat less common among Hispanics of Caribbean (such as Cuban and Puerto Rican) origin, possibly because of differences in education and socioeconomic status. Among white Hispanics in the U.S., Mexican and Central American ancestry has become increasingly predominant over time. Among black Hispanics, Caribbean ancestry still predominates. The differences in drinking styles among various groups of Hispanics may help to explain why their origin increases the risk of cirrhosis mortality among white but not among black Hispanics.

"The most important implication of these findings," added Bridget F. Grant, second author and chief of the Biometry Branch of the NIAAA, "is that Hispanic Americans are in need of targeted prevention and intervention programs that take into account language and other cultural issues. We also need further research into the importance of heavy drinking occasions and not just overall volume of alcohol intake as a risk factor for cirrhosis mortality."

"These findings have important prevention, policy development and treatment implications," said Stinson. "They have relevance for health care workers, epidemiologists (people who study numbers), and policy makers." Researchers at the NIAAA plan to continue with this research, seeking to determine if the risk for white Hispanics varies substantially from state to state.

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

Articles were written based on the following published research:

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