# Urban Versus Rural Disparities in Alcoholic Liver Disease Mortality: A Comprehensive 22-Year Analysis of Trends and Demographic Influences in the United States

## TL;DR

Rural areas in the U.S. are experiencing a sharper rise in deaths from alcoholic liver disease compared to urban areas, especially among younger and male populations.

## Contribution

This study provides a detailed 22-year analysis of ALD mortality disparities between urban and rural populations in the U.S., revealing demographic-specific trends.

## Key findings

- Rural mortality rates from ALD increased sharply after 2015, with a steeper rise compared to urban areas.
- Younger rural populations (25-34 years) and American Indian or Alaska Native individuals in rural areas had notably higher mortality rates.
- Rural males and females both showed significantly higher mortality rates compared to their urban counterparts.

## Abstract

Introduction

Alcoholic liver disease (ALD) encompasses a spectrum of liver conditions that result from excessive alcohol consumption. Disparities in mortality rates of ALD between urban and rural populations have become a growing concern, with rural areas experiencing a faster rise in ALD-related deaths. Understanding these disparities is crucial for developing targeted public health interventions to address this escalating concern.

Methodology

Disparities in mortality rates from 1999 to 2020 were analyzed using data from the CDC-WONDER (Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research) database. Regions were categorized into urban (large central, large fringe, medium, and small metro) and rural (micropolitan and non-core) categories based on the 2013 Metropolitan classification. The data were stratified by age (10-year intervals), gender, and race. The binomial proportion test was used for comparison, and a p-value < 0.05 was considered significant.

Results

Rural mortality rates increased sharply post-2015, peaking in 2020, while urban rates rose more gradually. While urban areas experienced higher total mortality, rural regions exhibited a steeper rise in mortality rates, especially post-2015, highlighting a growing public health crisis. Notably, younger age groups (15-64 years) exhibited higher mortality in rural areas, particularly among those aged 25-34 years, while urban areas showed higher rates for older populations (65+ years). American Indian or Alaska Native individuals in rural areas had notably high rates (24.1 per 100,000). Rural males experienced higher mortality rates (9.04 per 100,000) compared to urban males (7.82 per 100,000, p < 0.001). Similarly, rural females also exhibited higher mortality (3.48 per 100,000) compared to urban females (3.08 per 100,000, p < 0.001), highlighting a consistent rural disadvantage across both genders.

Conclusions

The findings of this study indicate that males and middle-aged adults in rural settings are disproportionately affected. Targeted public health interventions aimed at improving healthcare access can significantly reduce ALD mortality rates.