Deaths From Chronic Liver Disease and Viral Hepatitis, Multnomah County, Oregon, 2000

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Abstract
Goals 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. Background 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. Study 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. Results 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. Conclusions 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.