Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis

Abstract

Background & aims: Accurate estimates for the contemporary burden of chronic liver disease (CLD) are vital for setting clinical, research, and policy priorities. We aimed to review the incidence, prevalence, and mortality of CLD and its resulting complications, including cirrhosis and hepatocellular carcinoma (HCC).

Methods: We reviewed the published literature on the incidence, prevalence, trends of various etiologies of CLD and its resulting complications. In addition, we provided updated data from the Centers for Disease Control and Global Burden of Disease Study on the morbidity and mortality of CLD, cirrhosis, and hepatocellular carcinoma (HCC). Lastly, we assessed the strengths and weaknesses of available sources of data in hopes of providing important context to these national estimates of cirrhosis burden.

Results: An estimated 1.5 billion persons have CLD worldwide and the age-standardized incidence of CLD and cirrhosis is 20.7/100,000, a 13% increase since 2000. Similarly, cirrhosis prevalence and mortality has increased in recent years in the United States. The epidemiology of CLD is shifting, reflecting implementation of large-scale hepatitis B vaccination and hepatitis C treatment programs, the increasing prevalence of the metabolic syndrome, and increasing alcohol misuse.

Conclusions: The global burden of CLD and cirrhosis is substantial. Although vaccination, screening, and antiviral treatment campaigns for hepatitis B and C have reduced the CLD burden in some parts of the world, concomitant increases in injection drug use, alcohol misuse, and metabolic syndrome threaten these trends. Ongoing efforts to address CLD-related morbidity and mortality require accurate contemporary estimates of epidemiology and outcomes.

Keywords: Alcohol-related; Hepatitis B; Hepatitis C; Liver Cancer; Nonalcoholic Fatty Liver Disease.

Figure 1:. Global Burden of Cirrhosis Mortality

In this figure, abstracted from the Global Burden of Disease Study (https://vizhub.healthdata.org/gbd-compare/. accessed 4/2/19), we detail the age-adjusted risk of mortality (per 100,000 persons) attributed to cirrhosis. Legend (mortality per 100,000 persons): Dark to light blue (0-40). Yellow (40-50), Yellow-Orange (50-60), Orange-Red (60-70), Red (>70)

Figure 2:. Global Burden of Years Lost to Disability Due to Cirrhosis

In this this figure, we detail the years lost to disability (YLD) due to cirrhosis. YLD is a function of the disease incidence, the disability weight (on functioning) and the average duration of illness. Data abstracted from the Global Burden of Disease Study (https://vizhub.healthdata.org/gbd-compare/, accessed 4/2/19).

Figure 3:. Mortality Due to Chronic Liver Disease (CLD), Cirrhosis and Hepatocellular Carcinoma (HCC) in the US (1999-2017)

In the left panel we show how the age-adjusted mortality for CLD, cirrhosis, and HCC has changed over time. While HCC-related mortality has slowly climbed from 1999, mortality due to CLD and cirrhosis began rising after 2008, continuously through 2017 In the right panel we show the raw numbers of deaths attributed primarily to CLD, cirrhosis, and HCC for each year from 1999-2017