肝硬化给美国带来了巨大的健康和经济负担。减轻这一负担需要更好地了解肝硬化死亡率如何因种族和民族以及地理位置而变化。本研究描述了 2000 年至 2019 年美国 3110 个县五个种族和民族人口的肝硬化死亡率和趋势。我们使用先前验证的小区域估计按县、种族和民族以及年份 (2000-19) 估计了肝硬化死亡率方法、来自美国国家生命统计系统的死亡登记数据以及来自美国国家卫生统计中心的人口数据。考虑了五个种族和民族人口：美洲印第安人或阿拉斯加原住民（AIAN）、亚洲人或太平洋岛民（亚洲人）、黑人、拉丁裔或西班牙裔人（拉丁裔）以及白人。肝硬化死亡率估计值以 2010 年美国人口普查的年龄分布为标准进行了年龄标准化。对于每个种族和族裔人口，提供了年平均人口超过 1000 的所有县的估计值。从 2000 年到 2019 年，亚洲国家的国家级年龄标准化肝硬化死亡率下降（23·8% [95% 不确定区间19·6-27·8]，从每 100 000 人中有 9·4 人死亡 [8·9-9·9] 到每 100 000 人中有 7·1 人死亡 [6·8-7·5]），黑人 (22·8 % [20·6-24·8]，从每 100 000 19·8 [19·4-20·3] 到每 100 000 15·3 [15·0-15·6]），以及拉丁裔 (15· 3% [13·3-17·3]，从每 100 000 人 26·3 [25·6-27·0] 增加到每 100 000 人 22·3 [21·8-22·8]），并且在爱安 (39·3% [32·3-46·4]，2000 年从每 100 000 人 45·6 [40·6-50·6] 上升到每 100 000 人 63·5 [57·2-70·2]和 2019 年）和白人（25·8% [24·2-27·3]，从每 100 000 人 14·7 人死亡 [14·6-14·9] 到每 100 000 人 18·5 人死亡 [18·4] -18·7]) 人口。在所有年份中，亚洲人群的肝硬化死亡率最低，亚洲人群的肝硬化死亡率最高，并且每个种族和族裔人群中男性的死亡率高于女性。县级肝硬化死亡率的异质性程度因种族和族裔人口而异，亚洲人群的 IQR 最窄（每 100 000 人死亡中位数 8·0，IQR 6·4-10·4），而亚洲人群的 IQR 最宽。爱安人口 (55·1, 30·3-78·8)。在研究期间，几乎所有县的白人（3051 个县中的 2957 个 [96·9%]）和 AIAN（474 个县中的 421 个[88·8%]）的肝硬化死亡率均有所增加，但白人群体中一小部分县的肝硬化死亡率有所增加。亚洲人、黑人和拉丁裔人口。对于所有种族和族裔人口而言，2000 年至 2015 年期间肝硬化死亡率上升的县数多于 2015 年至 2019 年期间。2000 年至 2019 年期间，全国范围内和许多县的肝硬化死亡率均有所上升。尽管某些地方的种族和民族差异程度有所缩小，然而，差异仍然存在，许多地点和社区的死亡率仍然很高。我们的研究结果强调需要在国家和地方层面实施有针对性和因地制宜的计划和政策，以减轻肝硬化的负担。美国国立卫生研究院（校内研究计划、国家少数民族健康和健康差异研究所；国家心脏、肺和血液研究所；国家癌症研究所；国家关节炎和肌肉骨骼和皮肤疾病研究所；以及行为和社会科学研究办公室）。版权所有 © 2024 s）。由 Elsevier Ltd 出版。这是一篇采用 CC BY 4.0 许可的开放获取文章。由爱思唯尔有限公司出版。保留所有权利。

Cirrhosis is responsible for substantial health and economic burden in the USA. Reducing this burden requires better understanding of how rates of cirrhosis mortality vary by race and ethnicity and by geographical location. This study describes rates and trends in cirrhosis mortality for five racial and ethnic populations in 3110 US counties from 2000 to 2019.We estimated cirrhosis mortality rates by county, race and ethnicity, and year (2000-19) using previously validated small-area estimation methods, death registration data from the US National Vital Statistics System, and population data from the US National Center for Health Statistics. Five racial and ethnic populations were considered: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Cirrhosis mortality rate estimates were age-standardised using the age distribution from the 2010 US census as the standard. For each racial and ethnic population, estimates are presented for all counties with a mean annual population greater than 1000.From 2000 to 2019, national-level age-standardised cirrhosis mortality rates decreased in the Asian (23·8% [95% uncertainty interval 19·6-27·8], from 9·4 deaths per 100 000 population [8·9-9·9] to 7·1 per 100 000 [6·8-7·5]), Black (22·8% [20·6-24·8], from 19·8 per 100 000 [19·4-20·3] to 15·3 per 100 000 [15·0-15·6]), and Latino (15·3% [13·3-17·3], from 26·3 per 100 000 [25·6-27·0] to 22·3 per 100 000 [21·8-22·8]) populations and increased in the AIAN (39·3% [32·3-46·4], from 45·6 per 100 000 [40·6-50·6] to 63·5 per 100 000 [57·2-70·2] in 2000 and 2019, respectively) and White (25·8% [24·2-27·3], from 14·7 deaths per 100 000 [14·6-14·9] to 18·5 per 100 000 [18·4-18·7]) populations. In all years, cirrhosis mortality rates were lowest among the Asian population, highest among the AIAN population, and higher in males than females for each racial and ethnic population. The degree of heterogeneity in county-level cirrhosis mortality rates varied by racial and ethnic population, with the narrowest IQR in the Asian population (median 8·0 deaths per 100 000, IQR 6·4-10·4) and the widest in the AIAN population (55·1, 30·3-78·8). Cirrhosis mortality increased over the study period in almost all counties for the White (2957 [96·9%] of 3051 counties) and AIAN (421 [88·8%] of 474) populations, but in a smaller proportion of counties for the Asian, Black, and Latino populations. For all racial and ethnic populations, cirrhosis mortality rates increased in more counties between 2000 and 2015 than between 2015 and 2019.Cirrhosis mortality increased nationally and in many counties from 2000 to 2019. Although the magnitude of racial and ethnic disparities decreased in some places, disparities nonetheless persisted, and mortality remained high in many locations and communities. Our findings underscore the need to implement targeted and locally tailored programmes and policies to reduce the burden of cirrhosis at both the national and local level.US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.