Global burden of liver cirrhosis 1990-2019 and 20 years forecast: results from the global burden of disease study 2019

Abstract

Background: Cirrhosis is a disease that imposes a heavy burden worldwide, but its incidence varies widely by region. Therefore, we analysed data on the incidence and mortality of cirrhosis in 204 countries and territories from 1990-2019 and projected the disease development from 2019-2039.

Methods: Data on the incidence and mortality of liver cirrhosis from 1990 to 2019 were acquired from the public Global Burden of Disease (GBD) study. In addition, the average annual percentage change (AAPC) and estimated annual percentage change (EAPC) of the age-standardized rate (ASR) of cirrhosis in different regions were calculated. The estimates of risk factor exposure were summarized, and the proportion of causes and risk factors of liver cirrhosis and their relationship with the human development index (HDI) and socio-demographic index (SDI) were analysed. Trends in the incidence of cirrhosis in 2019-2039 were predicted using Nordpred and BAPC models.

Results: Globally, the ASR of cirrhosis incidence decreased by 0.05% per year from 25.7/100,000 in 1990 to 25.3/100,000 in 2019. The mortality risk associated with cirrhosis is notably lower in females than in males (13 per 100,000 vs 25 per 100,000). The leading cause of cirrhosis shifted from hepatitis B to C. Globally, alcohol use increased by 14%. In line, alcohol use contributed to 49.3% of disability-adjusted life years (DALYs) and 48.4% of global deaths from liver cirrhosis. Countries with a low ASR in 1990 experienced a faster increase in cirrhosis, whereas in 2019, the opposite was observed. In countries with high SDI, the ASR of cirrhosis is generally lower. Finally, projections indicate that the number and incidence of cirrhosis will persistently rise from 2019-2039.

Conclusions: Cirrhosis poses an increasing health burden. Given the changing etiology, there is an imperative to strengthen the prevention of hepatitis C and alcohol consumption, to achieve early reduce the incidence of cirrhosis.

Keywords: Cirrhosis; disease burden; liver disease; prediction; trend.

Figure 1.

Incidence of cirrhosis in 204 countries and regions worldwide burden of disease: A. ASR for the incidence of cirrhosis in 2019; B. Changes in the cases of cirrhosis from 1990 to 2019; C. EAPC analysis of cirrhosis ASR from 1990 to 2019. ASIR, age-standardized rate; EAPC, estimated annual percent change. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 2.

Disease burden of cirrhosis mortality in 204 countries and territories worldwide: A. ASR for cirrhosis mortality in 2019; B. Changes in the cases of cirrhosis from 1990 to 2019; C. EAPC analysis of cirrhosis ASR from 1990 to 2019. ASR, age-standardized rate; EAPC, estimated annual percent change. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 3.

Cluster analysis: Estimated annual percent change data combining incidence and deaths. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 4.

Contribution of hepatitis B, hepatitis C, NAFLD, alcohol use, and other causes to cirrhosis cases (in both genders), ­globally and regionally, in 1990 and 2019: A. The proportion of cirrhosis caused by various causes in 1990; B. The proportion of cirrhosis caused by various causes in 2019. NAFLD, Non-alcoholic fatty liver disease. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 5.

Summary exposure value changes of alcohol and drug use in 46 GBD regions from 1990 to 2019: A. Changes in SEV for alcohol use; B. Changes in SEV for alcohol use. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 6.

Proportion of DALYs and deaths from cirrhosis due to alcohol use and drug use in 46 GBD regions in 2019: A. Proportion of DALYs and death in cirrhosis due to alcohol use; B. Proportion of DALYs and death in cirrhosis due to drug use. DALYs, Disability Adjusted Life Year; GBD, Global Burden of Disease, Injury, and Risk Factors Study. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 7.

Correlation of EAPC with cirrhosis ASR and HDI: A. Correlation of EAPC with cirrhosis ASIR and ASDR in 1990. B. Correlation of EAPC with 2019 cirrhosis ASIR and ASDR. C. Correlation of EAPC with 2019 HDI. The circles in the figure represent countries, and the size of the circles represents the number of cases of cirrhosis. ρ and P values were obtained from Pearson correlation coefficient analysis. ASR, age–standardized rate; ASIR, age–standardized Incidence rate; ASDR, age–standardized death rate; EAPC, estimated annual percentage change; HDI, human development index. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 8.

ASR trends in cirrhosis by socio–demographic index, 1990–2019: A. 21 GBD regions; B. 204 countries and territories. Expected values for sociodemographic indices and disease incidence based on all sites are shown as black lines. ASR, age–standardized rate; GBD, Global Burden of Diseases, Injuries, and Risk Factors Study. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 9.

Statistics and predictions of the number of cases in all age groups: A. Prediction based on Nordpred model; B. Prediction based on BAPC model. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 10.

Cirrhosis incidence 1990–2019 and projections for the next 20 years, stratified by gender: A. Number of female cases; B. Female incidence rate; C. Number of male cases; D. Male incidence rate. Prediction of changes over the next 20 years based on the Nordpred model. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 11.

Cirrhosis incidence 1990–2019 and projections for the next 20 years, stratified by gender: A. Number of female cases; B. Female incidence rate; C. Number of male cases; D. Male incidence rate. Prediction of changes over the next 20 years based on the BAPC model. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.

Figure 12.

Statistics and predictions of cirrhosis ASR for different genders: A and B are based on the Nordpred model for females and males, respectively; C and D are based on the BAPC model, respectively. ASR, age–standardized rate. Source: Institute for Health Metrics and Evaluation. Used with permission. All rights reserved.