Age, Gender and Geographic Differences in Global Health Burden of Cirrhosis and Liver Cancer due to Nonalcoholic Steatohepatitis

Abstract

Objective: Recently, Nonalcoholic Steatohepatitis (NASH) has become a major contributor to cirrhosis and liver cancer. Therefore, the Global Burden of Disease (GBD) 2017 was used to comprehensively analyze the global, regional, and national burden of cirrhosis and liver cancer due to NASH between 1990 and 2017. Methods: Data for cirrhosis and liver cancer due to NASH were extracted from the GBD study 2017. Socio-demographic Index (SDI) in 2017 was cited as indicators of socioeconomic status. ARIMA model was established to forecast the future health burden. Kruskal-Wallis test and Pearson linear correlation were adopted to evaluate the gender disparity and association with socioeconomic level. Results: From 1990-2017, the global disability-adjusted life years (DALYs) numbers of liver cancer due to NASH increased from 0.71 million to 1.46 million. The age-standardized DALYs rates of liver cancer due to NASH were negatively associated with SDI levels (r=0.-409, p<0.001). Geographically, Australasia experienced the largest increase in the burden of liver cancer due to NASH, with the age-standardized DALYs rate increasing by 143.54%. The global prevalence number of liver cancer due to NASH peaked at 60-64 years in males and at 65-69 years in females. Globally, the burden was heavier in males compared with females. Male-female-ratio of age-standardized DALYs rates in liver cancer due to NASH were positively related to SDI (r=0.303, P=0.011). Conclusion: The global burden of NASH-associated liver cancer has increased significantly since 1990, with age, gender and geographic disparity. Public awareness of liver diseases due to NASH should be emphasized.

Keywords: Sociodemographic Index; cirrhosis; disability-adjusted life years; health burden; liver cancer; nonalcoholic steatohepatitis.

Figure 1

Global burden of cirrhosis and liver cancer due to NASH from 1990 to 2050. (A) Incidence number of cirrhosis due to NASH; (B) Prevalence number of cirrhosis due to NASH; (C) Death number of cirrhosis due to NASH; (D) DALYs number of cirrhosis due to NASH; (E) Incidence number of liver cancer due to NASH; (F) Prevalence number of liver cancer due to NASH; (G) Death number of liver cancer due to NASH; (H) DALYs number of liver cancer due to NASH. NASH: nonalcoholic steatohepatitis; DALYs: disability-adjusted life years. Dash line: forecasted NASH burden from 2018 towards 2050 through ARIMA model.

Figure 2

Global burden of cirrhosis and liver cancer due to NASH by age in 2017. (A) Prevalence number of cirrhosis due to NASH; (B) DALYs number of cirrhosis due to NASH; (C) Prevalence number of liver cancer due to NASH; (B) DALYs number of liver cancer due to NASH. NASH: nonalcoholic steatohepatitis; DALYs: disability-adjusted life years.

Figure 3

Global map of health burden of cirrhosis and liver cancer due to NASH in 2017. (A) Age-standardized DALYs rate of cirrhosis due to NASH; (B) Age-standardized DALYs rate of liver cancer due to NASH. NASH: nonalcoholic steatohepatitis; DALYs: disability-adjusted life years.

Figure 4

Health burden of cirrhosis and liver cancer due to NASH by GBD regions in 1990 and 2017. (A) Age-standardized DALYs rates of cirrhosis due to NASH (male); (B) Age-standardized DALYs rates of cirrhosis due to NASH (female); (C) Age-standardized DALYs rates of liver cancer due to NASH (male); (D) Age-standardized DALYs rates of liver cancer due to NASH (female). NASH: nonalcoholic steatohepatitis; DALYs: disability-adjusted life years.

Figure 5

Global burden of cirrhosis and liver cancer due to NASH by SDI levels in 2017. (A) Age-standardized DALYs rate of cirrhosis due to NASH in 195 countries; (B) Age-standardized DALYs rate of cirrhosis due to NASH in different SDI levels; (C) Association between male-female-ratio of age-standardized DALYs rate of cirrhosis due to NASH with SDI; (D) Age-standardized DALYs rate of liver cancer due to NASH in 195 countries; (E) Age-standardized DALYs rate of liver cancer due to NASH in different SDI levels; (F) Association between male-female-ratio of age-standardized DALYs rate of liver cancer due to NASH with SDI. NASH: nonalcoholic steatohepatitis; SDI: sociodemographic index; DALYs: disability-adjusted life years. (A and D) Each circle represents a country; circles are colored according to SDI quintile; circle size corresponds to the number.