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Identify deaths related to chronic liver disease (CLD) in 2000 among Multnomah County, Oregon residents and estimate the proportion of these deaths attributable to hepatitis B or hepatitis C.Although CLD is among the most common causes of mortality in the United States, little information is available regarding the proportion of CLD mortality attributable to viral hepatitis.We developed a comprehensive list of 117 International Classification of Disease-10 codes potentially related to CLD. We identified deaths among residents of Multnomah County, Oregon whose death certificates included any one of these 117 codes. We verified the history of CLD and viral hepatitis using a combination of hospital charts, medical examiner reports, and a clinical questionnaire mailed to the certifying physician.We verified that 118 patients had died of CLD in Multnomah County, Oregon in 2000; 38 (32%) of the death certificates listed hepatitis B or hepatitis C as the underlying or a contributing cause of death. By medical record review, an additional 16 patients were found to have hepatitis B or hepatitis C not indicated on the death certificate [total 54 (46%) patients with viral hepatitis]. The majority of the 38 patients with viral hepatitis listed on the death certificate had an International Classification of Disease-10 code indicating acute infection with hepatitis B or hepatitis C.Chronic viral hepatitis is often unreported on death certificates of patients with CLD and, when reported, may be incorrectly coded as acute instead of chronic infection.

To examine a wide range of sociodemographic and clinical characteristics as potential predictors of complementary and alternative medicine (CAM) use among chronic liver disease (CLD) patients, with a focus on CAM therapies with the greatest potential for hepatotoxicity and interactions with conventional treatments.There is some evidence that patients with CLD commonly use CAM to address general and CLD-specific health concerns.Patients enrolled in a population-based surveillance study of persons newly diagnosed with CLD between 1999 and 2001 were asked about current use of CAM specifically for CLD. Sociodemographic and clinical information was obtained from interviews and medical records. Predictors of CAM use were examined using univariate and multivariate logistic regression analysis.Of the 1040 participants, 284 (27.3%) reported current use of at least 1 of 3 CAM therapies of interest. Vitamins or other dietary supplements were the most commonly used therapy, reported by 188 (18.1%) patients. This was followed by herbal medicine (175 patients, 16.8%) and homeopathy (16 patients, 1.5%). Several characteristics were found to be independent correlates of CAM use: higher education and family income, certain CLD etiologies (alcohol, hepatitis C, hepatitis C and alcohol, and hepatitis B), and prior hospitalization for CLD.Use of CAM therapies that have the potential to interact with conventional treatments for CLD was quite common among this population-based sample of patients with CLD. There is a need for patient and practitioner education and communication regarding CAM use in the context of CLD.

To determine the etiologies of chronic liver disease among American Indians.American Indians are disproportionately affected by chronic liver disease, yet little is known about its underlying etiologies in this group.We conducted a cross-sectional prevalence study at medical centers serving American Indian populations in Arizona and California. Patients' records were reviewed to identify those with chronic liver disease (ICD-9 code for chronic liver disease or 2 abnormal liver testsor = 6 mo apart). ICD-9 codes and laboratory findings were abstracted to determine etiologies.Of the 30,698 American Indian patients seen at the Arizona center during 2000 to 2002, 1496 (4.9%) had chronic liver disease, including 268/1496 (17.9%) with decompensated cirrhosis. Etiologies included alcohol (621; 41.5%), hepatitis C (103; 6.9%), both (136; 9.1%), or nonalcoholic fatty liver disease (191; 12.8%). Among alcohol-related liver disease patients tested for hepatitis C, 32.2% were positive. Of the 6074 American Indian patients seen at the California center during 2002 to 2003, 344 (5.7%) had chronic liver disease, including 45/344 (13.1%) with decompensated cirrhosis. Etiologies included alcohol (57; 16.6%) hepatitis C (83; 24.1%), and both (42; 12.2%). In one-third of chronic liver disease patient at the 2 centers, no etiology could be identified; 30% to 45% had not been tested for hepatitis C.Alcohol-related liver disease and hepatitis C were the most commonly identified etiologies among these American Indian patients with chronic liver disease in clinical care. Identifying American Indian and Alaska Native patients with chronic liver disease and providing treatment are critical for reducing disease burden.

Background Primary care providers (PCPs) must identify persons at risk for hepatitis C virus (HCV) infection, test them correctly, refer to subspecialists, and use published guidelines. The objectives of this study were to describe HCV practices of New Haven County PCPs. Study All 652 PCPs in New Haven County, Connecticut, were surveyed to determine practices related to hepatitis C, including risk factor ascertainment, testing routines, use of published guidelines, and referral practices. Results Of 181 eligible respondents, 143 (79%) were internal medicine physicians and 38 (21%) were family practitioners. Eighty-four PCPs (46%) routinely asked about a history of blood transfusion, and 112 (62%) routinely asked about a history of injection drug use (IDU). Most PCPs would test current or past IDU (91% versus 83%, respectively), persons transfused prior to 1992 (79%), health care workers with a history of a needle stick accident (88%), and a child born to an HCV-infected mother (76%). PCPs frequently referred patients with hepatitis C to gastroenterologists. Most PCPs (76%) were familiar with available hepatitis C testing guidelines. Conclusions Most PCPs test for HCV infection appropriately, but many do not elicit risk factor histories that could identify such persons. More effective training with emphasis on eliciting a history of pertinent risk factors is needed.