Incidence, etiology and mortality of cirrhosis: a population-based cohort study

Abstract

Objective: Knowledge on the prognosis among patients with cirrhosis is mainly based on clinical trials with selected patient groups as well as population-based register studies with suboptimal diagnostic reliability. The aim of the study was to describe incidence, etiology, and mortality of well-validated cirrhotic cases in a population-based cohort at Funen (population 470,000) between 1996 and 2006.

Materials and methods: A population-based cohort study with case identification from discharge diagnosis followed by manual validation of patient records with inclusion of cases that fulfilled predefined diagnostic criteria.

Results: 4010 possible cases were identified. 1369 patients were included, 67% males, mean age 56.4 years, 75% had cirrhotic complications at entry. Mean follow-up was 3.6 years with a total of 4976 years of follow-up. The incidence was 33/100,000 person-years (95% confidence interval CI 28-40). Stratified for age and sex, the incidence was twice as high for men compared with women in all age groups. The five-year mortality was 62% (95% CI 59-65). A multivariate analysis showed a high mortality associated with male gender (HR 1.24, 95% CI 1.08-1.42), ages above 70 years (HR 2.01 95% CI 1.65-2.47) compared with ages 50-59 years, complications present at diagnosis (HR 1.28, 95% CI 1.09-1.50) and etiology of alcoholic disease or cryptogenic cirrhosis (HR 2.38, 95% CI 1.22-4.67 and 2.26, 95% CI 1.13-4.53).

Conclusions: Incidence of cirrhosis is higher among men than among women. High age, male gender, alcoholic cirrhosis, cryptogenic cirrhosis, and complications at the time of diagnosis increased mortality.