Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Sep 18:12:145.
doi: 10.1186/s12916-014-0145-y.

Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis

Ali A Mokdad, Alan D Lopez, Saied Shahraz, Rafael Lozano, Ali H Mokdad, Jeff Stanaway, Christopher J L Murray, Mohsen Naghavi

Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis

Ali A Mokdad et al. BMC Med. .

Abstract

Background: Liver cirrhosis is a major yet largely preventable and underappreciated cause of global health loss. Variations in cirrhosis mortality at the country level reflect differences in prevalence of risk factors such as alcohol use and hepatitis B and C infection. We estimated annual age-specific mortality from liver cirrhosis in 187 countries between 1980 and 2010.

Methods: We systematically collected vital registration and verbal autopsy data on liver cirrhosis mortality for the period 1980 to 2010. We corrected for misclassification of deaths, which included deaths attributed to improbable or nonfatal causes. We used ensemble models to estimate liver cirrhosis mortality with uncertainty by age, sex, country and year. We used out-of-sample predictive validity to select the optimal model.

Results: Global liver cirrhosis deaths increased from around 676,000 (95% uncertainty interval: 452,863 to 1,004,530) in 1980 to over 1 million (1,029,042; 670,216 to 1,554,530) in 2010 (about 2% of the global total). Over the same period, the age-standardized cirrhosis mortality rate decreased by 22%. This was largely driven by decreasing cirrhosis mortality rates in China, the US and countries in Western Europe. In 2010, Egypt, followed by Moldova, had the highest age-standardized cirrhosis mortality rates, 72.7 and 71.2 deaths per 100,000, respectively, while Iceland had the lowest. In Egypt, almost one-fifth (18.1%) of all deaths in males 45- to 54-years old were due to liver cirrhosis. Liver cirrhosis mortality in Mexico is the highest in Latin America. In France and Italy, liver cirrhosis mortality fell by 50% to 60%; conversely, in the United Kingdom, mortality increased by about one-third. Mortality from liver cirrhosis was also comparatively high in Central Asia countries, particularly Mongolia, Uzbekistan and Kyrgyzstan, and in parts of sub-Saharan Africa, notably Gabon.

Conclusions: Liver cirrhosis is a significant cause of global health burden, with more than one million deaths in 2010. Our study identifies areas with high and/or rapidly increasing mortality where preventive measures to control and reduce liver cirrhosis risk factors should be urgently strengthened.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Pre-corrected versus post-corrected liver cirrhosis deaths.
Figure 2
Figure 2
Population attributable fractions in liver cirrhosis by region in 1990 and 2010.
Figure 3
Figure 3
Liver cirrhosis deaths from 1980 to 2010 by region.
Figure 4
Figure 4
Age-adjusted liver cirrhosis mortality (per 100,000) for both sexes in 2010. ATG(Antigua and Barbuda), BRB(Barbados), COM(Comoros), DMA(Dominica), E Med(East Mediterranean), FJI(Fiji), FSM(Micronesia, Federated States of), GRD(Grenada), KIR(Kiribati), LCA(Saint Lucia), MDV(Maldives), MHL(Marshall Islands), MLT(Malta), MUS(Mauritius), PERS GULF(Persian Gulf), SGP(Singapore), SLB(Solomon Islands), SYC(Seychelles), TLS(Timor-Leste), TON(Tonga), TTO(Trinidad and Tobago), VCT(Saint Vincent and the Grenadines), VUT(Vanuatu), W AFR(West Africa), WSM(Samoa).
Figure 5
Figure 5
Percent change in age-adjusted liver cirrhosis mortality between 1980 and 2010. ATG(Antigua and Barbuda), BRB(Barbados), COM(Comoros), DMA(Dominica), E Med(East Mediterranean), FJI(Fiji), FSM(Micronesia, Federated States of), GRD(Grenada), KIR(Kiribati), LCA(Saint Lucia), MDV(Maldives), MHL(Marshall Islands), MLT(Malta), MUS(Mauritius), PERS GULF(Persian Gulf), SGP(Singapore), SLB(Solomon Islands), SYC(Seychelles), TLS(Timor-Leste), TON(Tonga), TTO(Trinidad and Tobago), VCT(Saint Vincent and the Grenadines), VUT(Vanuatu), W AFR(West Africa), WSM(Samoa).
Figure 6
Figure 6
Percent change in age-adjusted liver cirrhosis mortality between 1990 and 2000. ATG(Antigua and Barbuda), BRB(Barbados), COM(Comoros), DMA(Dominica), E Med(East Mediterranean), FJI(Fiji), FSM(Micronesia, Federated States of), GRD(Grenada), KIR(Kiribati), LCA(Saint Lucia), MDV(Maldives), MHL(Marshall Islands), MLT(Malta), MUS(Mauritius), PERS GULF(Persian Gulf), SGP(Singapore), SLB(Solomon Islands), SYC(Seychelles), TLS(Timor-Leste), TON(Tonga), TTO(Trinidad and Tobago), VCT(Saint Vincent and the Grenadines), VUT(Vanuatu), W AFR(West Africa), WSM(Samoa).
See this image and copyright information in PMC

References

    1. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–2223. doi: 10.1016/S0140-6736(12)61689-4. - DOI - PubMed
    1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128. doi: 10.1016/S0140-6736(12)61728-0. - DOI - PMC - PubMed
    1. Bosetti C, Levi F, Lucchini F, Zatonski WA, Negri E, La Vecchia C. Worldwide mortality from cirrhosis: an update to 2002. J Hepatol. 2007;46:827–839. doi: 10.1016/j.jhep.2007.01.025. - DOI - PubMed
    1. Corrao G, Ferrari P, Zambon A, Torchio P, Aricò S, Decarli A. Trends of liver cirrhosis mortality in Europe, 1970–1989: age-period-cohort analysis and changing alcohol consumption. Int J Epidemiol. 1997;26:100–109. doi: 10.1093/ije/26.1.100. - DOI - PubMed
    1. Zatoński WA, Sulkowska U, Mańczuk M, Rehm J, Boffetta P, Lowenfels AB, La Vecchia C. Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe. Eur Addict Res. 2010;16:193–201. doi: 10.1159/000317248. - DOI - PubMed

Publication types