The burden of liver cirrhosis and underlying etiologies: results from the Global Burden of Disease Study 2019

Abstract

Background: Liver cirrhosis and other chronic liver diseases are major health concerns. [corrected]. Herein, we aimed to estimate the incidence, prevalence, and mortality of liver cirrhosis and other chronic liver diseases (collectively referred to as liver cirrhosis in this paper) [corrected] caused by specific etiologies for 204 countries and territories.

Materials and methods: The data were retrieved from the Global Burden of Disease Study 2019. The age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized death rate, and estimated annual percentage changes were used to estimate the trends in incidence, prevalence, and mortality of liver cirrhosis by sex, region, country, and etiology between 2009 and 2019.

Results: From 2009 to 2019, the incident cases of liver cirrhosis increased by 16.7%, from 1.8 million (95% uncertainty interval: 1.5-2.1) to 2.1 million (1.7-2.5), and the prevalent cases increased from 1378.3 million (1275.1-1498.8) to 1691.0 million (1560.9-1845.5). Liver cirrhosis contributed to nearly 1.5 million (1.4-1.6) deaths in 2019, nearly 0.2 million more than in 2009. However, the age-standardized death rate fell from 20.71 (19.79-21.65) per 100,000 population in 2009 to 18.00 (16.80-19.31) per 100,000 population in 2019. In terms of sex, males showed higher ASIR, ASPR, and age-standardized death rate than females. Among the etiologies, the ASIR and ASPR of NAFLD increased markedly, and there was also a modest increase in ASIR and ASPR for HCV and alcohol use. In contrast, the ASIR and ASPR of HBV decreased considerably.

Conclusions: Our finding suggests an increasing burden of liver cirrhosis worldwide but a declining attributed death. A high prevalence and still rising trend of NAFLD and alcohol use-etiology were found in patients with cirrhosis globally, although variation was found between regions/countries. These data indicate that efforts to reduce the associated burden need to be improved.

Graphical abstract

FIGURE 1

Composition ratio of each etiology of liver cirrhosis incident cases, prevalent cases, and deaths in 2009 and 2019. A, Incident cases. B, Prevalent cases. C, Deaths. Abbreviation: SDI, socio-demographic index.

FIGURE 2

The age-standardized rates and EAPC for liver cirrhosis in 204 countries and territories in 2019. A, ASIR. B, ASPR. C, ASDR. D, EAPC of ASIR. E, EAPC of ASPR. F, EAPC of ASDR. Abbreviations: ASDR, age-standardized death rate; ASIR, age-standardized incidence rate; ASPR, Age-standardized prevalence rate; EAPC, estimated annual percentage changes; NA, not applicable.

FIGURE 3

The age-standardized rates for liver cirrhosis by region and sex, 2019. A, ASIR. B, ASPR. C, ASDR. Error bars indicate 95% uncertainty intervals for age-standardized rates. Abbreviations: ASDR, age-standardized death rate; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; SDI, socio-demographic index.

FIGURE 4

The age-standardized rates of liver cirrhosis globally and for 21 regions by SDI, 2009–2019. A, ASIR per 100,000 population. B, ASPR per 100,0000 population. C, ASDR per 100,000 population. For each region, the dots from left to right depict the estimated values for each year from 2009 to 2019. The black line shows the expected incidence, prevalence, or mortality rate based on SDI alone. Abbreviations: ASDR, age-standardized death rate; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; SDI, socio-demographic index.