ArticleGastroenterology2021
County Differences in Liver Mortality in the United States: Impact of Sociodemographics, Disease Risk Factors, and Access to Care.
Article in Gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed.
- Health Status And Delays In Referral-To-Treatment Waiting Times for Elective Admissions of Adults From Deprived Areas And Ethnic Minority Backgrounds: A Study of Healthcare Inequalities.Journal of racial and ethnic health disparities · 2026Article
- Portal hypertension mortality in the United States (1999-2023): Insights from the CDC WONDER database.Medicine · 2026Article
- Temporal Trends and Demographic Disparities in Respiratory Failure Mortality Among Adults with Chronic Liver Disease: A National Mortality Database Analysis, 1999 to 2024.Diseases (Basel, Switzerland) · 2026Article
- Barriers to Medical Care Are Frequently Reported by Patients With Cirrhosis.Alimentary pharmacology & therapeutics · 2026Article
- Disparities in Diagnosis, Management, and Outcomes of Hepatocellular Carcinoma: A Review of Global and Sociodemographic Factors.Journal of gastrointestinal cancer · 2026Review
- Differential gastrointestinal mortality in Native Hawaiian/Pacific Islander and Asian subgroups in the U.S.: a cross-sectional analysis of national mortality surveillance data 2018-2023.Lancet regional health. Americas · 2026Article
- Demographic and regional trends of mortality in patients with cardiovascular disease and liver cirrhosis in the United States between 1999 and 2019.Atherosclerosis plus · 2025Article
- Sex disparities in alcohol-associated liver disease and subtype differences in alcohol-attributable cancers in the United States.Clinical and molecular hepatology · 2025Article
- Article
- COVID-19 Pandemic-Related Disruptions in Routine Cirrhosis Care and Associated Clinical Outcomes among San Francisco Bay Area Veterans.Gastro hep advances · 2025Article
- The War on Drugs, Racialized Capitalism, and Health Care Utilization Among White People Who Use Drugs in 22 Rural Appalachian Counties.American journal of public health · 2024Article
- The burden of cirrhosis mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities.The Lancet. Public health · 2024Article
- Latent class analysis of chronic disease co-occurrence, clustering and their determinants in India using Study on global AGEing and adult health (SAGE) India Wave-2.Journal of global health · 2024Article
- Burden of liver cancer mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities.The Lancet. Public health · 2024Article
- Prevalence of Healthcare Barriers Among US Adults With Chronic Liver Disease Compared to Other Chronic Diseases.Gastro hep advances · 2024Article
- Health care-related transportation insecurity is associated with adverse health outcomes among adults with chronic liver disease.Hepatology communications · 2024Article
- Area-Level Social Determinants of Alcohol-Related Mortality: Knowledge Gaps and Implications for Community Health.Alcohol research : current reviews · 2024Review
- Disparities in treatment and survival in early-stage hepatocellular carcinoma in California.Journal of surgical oncology · 2023Article
- Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective.Healthcare (Basel, Switzerland) · 2023Review
- Acuity circles allocation policy impact on waitlist mortality and donation after circulatory death liver transplantation: A nationwide retrospective analysis.Health science reports · 2023Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
BACKGROUND AND
aimsData have demonstrated state-wide variability in mortality rates from liver disease (cirrhosis + hepatocellular carcinoma), but data are lacking at the local level (eg, county) to identify factors associated with variability in liver disease-related mortality and hotspots of liver disease mortality.
methodsWe used Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research data from 2009 to 2018 to calculate county-level, age-adjusted liver disease-related death rates. We fit multivariable linear regression models to adjust for county-level covariates related to demographics (ie, race and ethnicity), medical comorbidities (eg, obesity), access to care (eg, uninsured rate), and geographic (eg, distance to closest liver transplant center) variables. We used optimized hotspot analysis to identify clusters of liver disease mortality hotspots based on the final multivariable models.
resultsIn multivariable models, 61% of the variability in among-county mortality was explained by county-level race/ethnicity, poverty, uninsured rates, distance to the closest transplant center, and local rates of obesity, diabetes, and alcohol use. Despite adjustment, significant within-state variability in county-level mortality rates was found. Of counties in the top fifth percentile (ie, highest mortality) of fully adjusted mortality, 60% were located in 3 states: Oklahoma, Texas, and New Mexico. Adjusted mortality rates were highly spatially correlated, representing 5 clusters: South Florida; Appalachia and the eastern part of the Midwest; Texas and Oklahoma; New Mexico, Arizona, California, and southern Oregon; and parts of Washington and Montana.
conclusionsOur data demonstrate significant intrastate differences in liver disease-related mortality, with more than 60% of the variability explained by patient demographics, clinical risk factors for liver disease, and access to specialty liver care.
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