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. 2018 Jan 22;15(1):170.
doi: 10.3390/ijerph15010170.

Global Mortality Burden of Cirrhosis and Liver Cancer Attributable to Injection Drug Use, 1990-2016: An Age-Period-Cohort and Spatial Autocorrelation Analysis

Jin Yang  1 , Yunquan Zhang  2 , Lisha Luo  3 , Runtang Meng  4 , Chuanhua Yu  5   6
Affiliations

Global Mortality Burden of Cirrhosis and Liver Cancer Attributable to Injection Drug Use, 1990-2016: An Age-Period-Cohort and Spatial Autocorrelation Analysis

Jin Yang et al. Int J Environ Res Public Health. .

Abstract

We analyzed the temporal and spatial variations in mortality burden of cirrhosis and liver cancer attributable to injection drug use (IDU) from 1990 to 2016. Mortality data of IDU-attributable cirrhosis and IDU-attributable liver cancer on the global and national scales from 1990 to 2016 were collected from the Global Burden of Disease (GBD) studies. Age-period-cohort (APC) model analysis was used to analyze the global mortality trends of target disease, and spatial autocorrelation analysis based on Geographic Information System was applied to illustrate the clusters of the most epidemic countries. Globally, from 1990 to 2015, mortality rates (age-standardized, per 100,000) of IDU-attributable cirrhosis increased continually from 1.5 to 1.9, while from 0.4 to 0.9 for IDU-attributable liver cancer. The APC model analysis indicated that the increases of mortality were mainly driven by period effects, with the mortality risk increasing by 6.82-fold for IDU-attributable cirrhosis and 3.08-fold for IDU-attributable liver cancer. The spatial analysis suggested that IDU-attributable cirrhosis mortality were geographically clustered from 1990 to 2016, and hot spots were mainly located in less well developed countries of Latin America, East and Central Europe and Central Asia. Our study provides epidemiological evidence for global interventions against advanced liver disease among injection drug users (IDUs).

Keywords: age-period-cohort model analysis; cirrhosis; injection drug use; liver cancer; mortality burden; spatial autocorrelation analysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Risk-specific disease mortality on the global level in 1990 and 2016 for (a) cirrhosis; (b) liver cancer. IDU: injection drug use; BMI: body-mass index; FPG: fasting plasma glucose.
Figure 2
Figure 2
Mortality rates (age-standardized, per 100,000) of IDU-attributable cirrhosis and IDU-attributable liver cancer, 1990–2015, globally.
Figure 3
Figure 3
Age effects on mortality rates of IDU-attributable cirrhosis and IDU-attributable liver cancer.
Figure 4
Figure 4
Period effects on mortality rates of IDU-attributable cirrhosis and IDU-attributable liver cancer.
Figure 5
Figure 5
Cohort effects on mortality rates of IDU-attributable cirrhosis and IDU-attributable liver cancer.
Figure 6
Figure 6
Mortality rates (age-standardized, per 100,000) of (a) IDU-attributable cirrhosis and (b) IDU-attributable cirrhosis in 1990 and 2016, by country.
Figure 7
Figure 7
Local spatial autocorrelation for IDU-attributable cirrhosis mortality among 195 countries, 1990–2016.
See this image and copyright information in PMC

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