Trends in Cause-Specific Mortality by Race and Hispanic Origin, 1999–2019

Diseases of the Digestive System

Across the RE groups, the percentages of all deaths that were caused by diseases of the digestive system in 2019 ranged from 3.0 percent in the Black population to 5.7 percent among Hispanic people. This section discusses the six digestive system disease subcategories listed in Box 9.

Chart 32 shows the count and the percentage distribution of digestive system disease–related deaths by cause-of-death subcategory for 1999 and 2019, with detail by RE group and age. Alcoholic liver disease was the primary cause of digestive system disease–related death among Hispanic males in 2019, accounting for 43.4 percent of those deaths, compared with 25.7 percent for WNH males and about 20 percent for Black and API males. Similarly, the share of digestive system disease deaths caused by other liver disease in 2019 was disproportionately high among Hispanic females, at 44.9 percent, compared with 30.3 percent for API females, 27.9 percent for WNH females, and 26.4 percent for Black females. Relative to other RE groups, the Hispanic population experienced higher incidence, more aggressive progression patterns, and poorer treatment outcomes for chronic liver diseases such as nonalcoholic fatty liver disease, alcoholic cirrhosis, and viral hepatitis B and C (Carrion and others 2011). Environmental risk factors and genetic differences are thought to play a role in these disparities.

The share of digestive system disease–related deaths that was caused by alcoholic liver disease increased from 1999 to 2019, was more prevalent among men than women, and was disproportionately high in the Hispanic community. At ages 25–64, it was the primary cause of digestive system disease–related death in 2019 for men in all RE groups and for WNH women.

Chart 33 shows age-adjusted death rates for 1999–2019 by RE group, sex, and age group. Panel A shows the rates for digestive system diseases overall.

Chart 33, Panel B shows that Hispanic males had the highest all-ages alcoholic liver disease mortality rate in 2019, followed by WNH males, Black males, and WNH females. In 2019, the mortality rate for Hispanic males was 1.4 times higher than that of WNH males and 2.3 times that of Black males. The all-ages alcoholic liver disease mortality rate among WNH females in 2019 was 1.6 times higher than that of Hispanic females and 1.7 times that of Black females. Mortality rates were lower in 2019 than in 1999 for only three RE/sex groups: Hispanic males and Black males and females. During this period, the all-ages alcoholic liver disease death rate more than doubled for WNH females, from 2.0 to 4.5, and rose by 47.8 percent among WNH males. This trend exemplifies the rise in deaths of despair discussed earlier. Notably, alcoholic liver disease mortality rose for every RE/sex group in the second half of the period (2010–2019).

At all ages, other (nonalcohol-related) liver disease was the primary cause of digestive system disease–related deaths among WNH, Black, and API males and Hispanic, WNH, and API females. The share of digestive system disease–related deaths that was caused by nonalcoholic liver disease was disproportionately high for Hispanic females (44.9 percent).

Chart 33, Panel C shows that in 2019, Hispanic males had the highest all-ages nonalcohol-related liver disease mortality rate (11.1), followed by WNH males (10.0), Hispanic females (9.5), Black males (7.7), and WNH females (7.4). The mortality rates among Hispanic males and females were respectively 1.4 and 1.9 times greater than those of their Black counterparts. At ages 65 or older, Hispanic women had the highest nonalcohol-related liver disease death rate in 2019 (52.4), which corresponds with their disproportionately high share of digestive system disease deaths from this cause. Over the 1999–2019 period, all-ages nonalcohol-related liver disease mortality rates declined for most RE/sex groups. The exceptions were Hispanic females and WNH males, whose mortality rates rose slightly (by 2.3 percent and 5.1 percent, respectively), and WNH females, whose death rate rose by 30.7 percent, from 5.7 to 7.4.

The proportion of digestive system disease–related deaths that were caused by diseases of the esophagus, stomach, and duodenum ranged in 2019 from 4.0 percent in the Hispanic population to 9.1 percent among API people. The share declined from 1999 to 2019 and peaked at older ages, reaching, for instance, 14.1 percent of digestive system disease–related deaths among API individuals aged 85 or older.

Chart 33, Panel D shows that in 2019, Black males were the RE/sex group with the highest all-ages esophagus/stomach/duodenum disease mortality rate (2.2), followed by WNH males (2.1) and WNH females (1.7). However, WNH males had the highest all-ages esophagus/stomach/duodenum disease mortality rate from 2011 through 2018. At ages 25–64, esophagus/stomach/duodenum disease mortality rates were higher for Black men than for WNH men; but at older ages, the opposite was true. Black females had significantly lower esophagus/stomach/duodenum disease mortality rates than WNH females over the entire 1999–2019 period, both at ages 65 or older and over all ages combined. Over the 1999–2019 period, all-ages esophagus/stomach/duodenum disease mortality rates declined for all RE/sex groups. For Hispanic and API males, as well as Black and API females, the all-ages death rate dropped by more than half over the period.

Of the digestive system diseases, the subcategory labeled “other diseases of intestines” became the primary cause of death among Black females in 2019, when it accounted for 28.1 percent of those deaths. Within the subcategory, about 66 percent of deaths involved vascular disorders of the intestines (inadequate blood supply), intestinal obstructions, and paralytic ileus (lack of muscle contractions). This subcategory accounts for a greater share of digestive system disease–related mortality for females than for males regardless of RE group. Other intestinal disorders account for a greater proportion of digestive system–related deaths in the Black and WNH populations than in the other RE groups. This subcategory also accounts for the greatest share of digestive system disease mortality at ages 85 or older in all RE groups.

Chart 33, Panel E shows that in 2019, Black males had the highest all-ages mortality rate from other intestinal diseases (6.7), followed by WNH females (6.1), Black females (5.7), and WNH males (5.1). Other intestinal disease death rates at ages 25–64 were higher for Black individuals than WNH people regardless of sex. However, at ages 65 or older, WNH women and Black men had similar death rates, while Black women had a higher mortality rate than WNH men. From 1999 to 2019, all-ages mortality from other intestinal diseases declined in all RE/sex groups.

At all ages, the shares of digestive system disease–related deaths that were attributed to disorders of the gallbladder, biliary tract, and pancreas ranged in 2019 from 6.4 percent for Hispanic people to 13.0 percent among the API population, with the gallbladder/biliary tract/pancreas disorder share of digestive system disease–related deaths typically highest at the oldest ages.

Chart 33, Panel F shows that Black males had the highest all-ages gallbladder/biliary tract/pancreas disorder death rate from 1999 until about 2011, when the mortality rates of WNH and Black males began to converge, such that by 2019, both were 2.9. A similar pattern appears in the all-ages gallbladder/biliary tract/pancreas disorder mortality rates of WNH and Black females. Mortality rates declined during the period in all RE/sex groups, especially among non-WNH groups.

The residual subcategory “all other diseases of the digestive system” includes diseases of the oral cavity and the salivary glands; diseases of the appendix; hernias; noninfective enteritis and colitis; and diseases of the peritoneum. The share of digestive system–related deaths that was attributed to this group of disorders ranged in 2019 from about 8 percent among Hispanic individuals to about 16 percent for API and Black people. At ages 85 or older, other digestive system diseases constituted about one-quarter of digestive system disease–related deaths among the API, WNH, and Black populations.

Chart 33, Panel G shows that in 2019, Black and WNH males had the highest all-ages other-digestive-disease death rates (5.1 and 4.8, respectively), followed by WNH females (3.8) and Black females (3.5). The all-ages other-digestive-disease death rates declined for all RE/sex groups during the 1999–2019 period.

In summary, mortality caused by diseases of the digestive system shows a great deal of heterogeneity by RE/sex group, most notably with the Hispanic population exhibiting disproportionately high liver-disease mortality. Chart 34 shows the all-ages digestive disease mortality rates by cause-of-death subcategory, RE group, and sex in 1999 and 2019. In 1999, the death rate for Hispanic males (44.7) was slightly higher than that of Black males (44.1). However, the mortality-cause composition was quite different between the two populations, as Black males had substantially lower mortality from both alcoholic and other liver disorders, but higher mortality from all other subcategories, particularly other intestinal diseases and all other digestive system diseases. WNH males had significantly lower digestive system disease mortality rates than Black and Hispanic males in 1999, and alcoholic and other liver disease mortality among Hispanic males exceeded the mortality rate from all digestive system–related causes for API men. By 2019, the death rate from diseases of the digestive system had barely budged among WNH males, as increases in alcoholic and other liver disease mortality were offset by declines in other causes. By contrast, mortality rates decreased for males in the other RE groups, resulting in similar overall digestive-disorder mortality rates in 2019 between those who are WNH (34.2) and Hispanic (34.5) and a lower mortality rate for Black males (30.0).

Among females, the mortality rate from diseases of the digestive system in 1999 was highest among the Black RE group (28.7), followed by the Hispanic and WNH groups (25.4 and 24.9, respectively). By 2019, the digestive system disease death rate was highest in the WNH RE group, driven largely by a substantial increase in the mortality associated with diseases of the liver, while Black females had lower mortality rates than Hispanic females.