alcohol-induced deaths may have been influenced by coexisting conditions otherwise affecting the liver (eg, hepatitis C infection or nonalcoholic fatty liver disease).38,39 Misclassification of race/ethnicity data within death certificates is also possible in our study but is minimal for groups other than AIAN individuals, for whom we took measures to limit misclassification.3 Also, our analyses of county-level factors were limited to white, black, and Latino individuals, and our analysis by state was limited to white individuals; these exclusions were made because of sparse data for minority groups within the subdivisions.
