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Disparities in Social Vulnerability and Premature Mortality among Decedents with Hepatitis B, United States, 2010–2019

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Abstract

Background

Current US hepatitis B mortality rates remain three times higher than the national target. Mortality reduction will depend on addressing hepatitis B disparities influenced by social determinants of health.

Objectives

This study aims to describe characteristics of hepatitis B–listed decedents, which included US birthplace status and county social vulnerability attributes and quantify premature mortality.

Methods

We conducted a cross-sectional analysis of 17,483 hepatitis B–listed decedents using the 2010–2019 US Multiple-Cause-of-Death data merged with the county-level Social Vulnerability Index (SVI). Outcomes included the distribution of decedents according to US birthplace status and residence in higher versus lower death burden counties by sociodemographic characteristics, years of potential life lost (YPLL), and SVI quartiles.

Results

Most hepatitis B–listed decedents were US-born, male, and born during 1945–1965. Median YPLL was 17.2; 90.0% died prematurely. US-born decedents were more frequently White, non-college graduates, unmarried, and had resided in a county with < 500,000 people; non-US-born decedents were more frequently Asian/Pacific Islander, college graduates, married, and had resided in a county with ≥ 1 million people. Higher death burden (≥ 20) counties were principally located in coastal states. US-born decedents more frequently resided in counties in the highest SVI quartile for “Household Characteristics” and “Uninsured,” whereas non-US-born decedents more frequently resided in counties in the highest SVI quartile for “Racial/Ethnic Minority Status” and “Housing Type/Transportation.”

Conclusion

This analysis found substantial premature hepatitis B mortality and residence in counties ranked high in social vulnerability. Successful interventions should be tailored to disproportionately affected populations and the social vulnerability features of their geographic areas.

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Data Availability

Restricted-use US Multiple Cause of Death data were acquired through an approved project determination to the CDC National Center for Health Statistics to obtain information on state and county of decedent residence and birth. The public-use CDC Social Vulnerability Index data were obtained from the CDC’s Agency for Toxic Substances and Disease Registry website.

Code Availability

Statistical codes used for these analyses are available upon request.

Abbreviations

ATSDR:

Agency for Toxic Substances and Disease Registry

CCOD:

Contributing cause of death

CDC:

US Centers for Disease Control and Prevention

CHB:

Chronic hepatitis B

CI:

Confidence interval

COD:

Cause of death

DC:

District of Columbia

DHHS:

US Department of Health and Human Services

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HIV:

Human immunodeficiency virus

HDV:

Hepatitis D virus

ICD-10:

International Classification of Diseases, Tenth Revision

IQR:

Interquartile range

MCOD:

Multiple Cause of Death

NCHS:

National Center for Health Statistics

SDOH:

Social determinants of health

SVI:

Social vulnerability index

UCOD:

Underlying cause of death

US:

United States

YPLL:

Years of potential life lost

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Acknowledgements

The authors thank the staff of state and local health departments who provide death certificate data to the National Center for Health Statistics.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop US12-3, Atlanta, GA, 30333, USA

    Kathleen N. Ly, Shaoman Yin & Philip R. Spradling

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  2. Shaoman Yin
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  3. Philip R. Spradling
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Kathleen Ly, Shaoman Yin, and Philip Spradling. The first draft of the manuscript was written by Kathleen Ly and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. CDC scientific coauthors were involved in the design and conduct of the study; analysis and interpretation of the data; preparation, review, and approval of the manuscript; and the decision to submit the manuscript for publication. Collection and management of the original source US Multiple Cause of Death data were conducted prior to this analysis through an ongoing cooperative agreement between each state health department and the CDC’s National Center for Health Statistics.

Corresponding authors

Correspondence to Kathleen N. Ly or Philip R. Spradling.

Ethics declarations

Ethical Approval

This analysis did not require institutional review board review per HHS Code of Federal Regulations Title 45 Part 46 2018 because de-identified data were obtained for decedents from secondary sources.

Consent to Participate

This study was deemed exempt from institutional review board review and informed consent per HHS Code of Federal Regulations Title 45 Part 46 2018 because all data were obtained from secondary sources without personally identifiable information.

Consent for Publication

This study was deemed exempt from institutional review board review and informed consent per HHS Code of Federal Regulations Title 45 Part 46 2018 because all data were obtained from secondary sources without personally identifiable information.

CDC Disclaimer

The findings and conclusions in this report do not necessarily reflect the official position of the Centers for Disease Control and Prevention.

Conflict of Interest

The authors declare no competing interests.

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Ly, K.N., Yin, S. & Spradling, P.R. Disparities in Social Vulnerability and Premature Mortality among Decedents with Hepatitis B, United States, 2010–2019. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-01968-4

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