In 1998, chronic liver disease (CLD) was the tenth leading cause of death in the U.S. Alcohol and hepatitis C are thought to be important etiologies. However, traditional methods for calculating CLD mortality rates from death certificates may underestimate hepatitis C-related CLD mortality. We studied patterns of CLD deaths reported from 1990 through 1998, using an expanded definition that included death certificates where CLD, viral hepatitis, or CLD-related sequelae were reported as the underlying cause. We calculated overall age-specific and age-adjusted mortality rates, and according to demographic characteristics and recorded causes, and evaluated trends using linear regression modeling. CLD mortality declined 5% overall from 1990 through 1994 (12.1 to 11.6/100,000; P = 0.002), but remained unchanged from 1995 through 1998 (P = 0.366). Decreases were similar for all causes except hepatitis C, for which rates increased 220% from 1993 to 1998 (0.57 to 1.67/100,000). Rates declined in all racial-ethnic groups except American Indians and Alaska Natives (AI/AN), among whom rates were unchanged. Of 30,933 CLD deaths in 1998, 39% were coded as alcohol related, 15% as hepatitis C, 4% as hepatitis B, and 44% had no recorded cause. Age-adjusted rates were higher among males (47.6/100,000) than females (32.2/100,000) and among Hispanics (19.1/100,000) compared with non-Hispanics (10.8/100,000). Rates among AI/AN (28.7/100,000) were more than twice those of African Americans and whites (12.9/100,000 and 11.5/100,000, respectively). In conclusion, 1998 CLD deaths and the proportion attributable to viral hepatitis increased by 23% and 19%, respectively, compared with traditional methods. Mortality declines of the early 1990s were not sustained after 1994. Large disparities in CLD mortality remain, particularly among American Indians and Alaska Natives. (Hepatology 2004;39:476-483.)