Hepatitis A–Related Mortality in California, 1989–2000: Analysis of Multiple Cause–Coded Death Data

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Abstract
Objectives. We estimated the hepatitis A (HA) mortality rate in California, assessed demographic differences in HA-related mortality, and examined comorbidities listed on death certificates in order to provide information for health policy and planning related to HA vaccination. Methods. We identified HA-related deaths in California from 1989 to 2000 with multiple-cause-of-death files and calculated mortality rates and rate ratios. Results. We identified 402 HA-related deaths between 1989 and 2000; the annual age-adjusted HA-related mortality rate was 1.20 deaths per 1 million persons. Older individuals, men, Latinos, and American Indians/Alaska Natives had elevated mortality rates. Liver conditions and non-A viral hepatitis infections were more common among HA-related deaths than among all other deaths. Conclusions. Current immunization practices should be reevaluated and the expansion of current vaccination guidelines for groups that have elevated HA-related mortality rates should be considered.