Abstract
There is a paucity of health policy relevant data for chronic liver disease from India, impeding formulation of an interventional strategy to address the issue. A prospective, multicentric study to delineate the etiology and clinical profile of chronic liver disease in India is reported here. A centrally coordinated and monitored web-based data repository was developed (Feb, 2010 to Jan, 2013) and analyzed. Eleven hospitals from different parts of India participated. Data were uploaded into a web based proforma and monitored by a single centre according to a standardized protocol. 1.28% (n = 266621) of all patients (n = 20701383) attending the eleven participating hospitals of India had liver disease. 65807 (24·68%) were diagnosed for the first time (new cases). Of these, 13014 (19·77%, median age 43 years, 73% males) cases of chronic liver disease were finally analyzed. 33.9% presented with decompensated cirrhosis. Alcoholism (34·3% of 4413) was the commonest cause of cirrhosis while Hepatitis B (33·3%) was predominant cause of chronic liver disease in general and non-cirrhotic chronic liver disease (40·8% out of 8163). There was significant interregional differences (hepatitis C in North, hepatitis B in East and South, alcohol in North-east, Non-alcoholic Fatty Liver Disease in West) in the predominant cause of chronic liver disease. Hepatitis B (46·8% of 438 cases) was the commonest cause of hepatocellular Cancer.11·7% had diabetes. Observations of our study will help guide a contextually relevant liver care policy for India and could serve as a framework for similar endeavor in other developing countries as well.
Highlights
Chronic liver diseases (CLD) cause significant morbidity and mortality worldwide
It is intriguing to note that most countries in these region have very poor vital events reporting systems, indicating that the current data could underestimate the existing situation and complimentary approaches are needed to assess the overall impact of CLDs on health systems [4,5,6,7]
Comparison between the patients above and below poverty line (APL vs Below poverty line (BPL)) shows that HCV is the second most frequent etiology in above poverty line (APL) group, whereas, alcohol is in BPL group
Summary
Chronic liver diseases (CLD) cause significant morbidity and mortality worldwide. Multiple etiological factors lead to a similar clinico-pathological syndrome in CLDs, the rates of progression and clinical course may be different [1,2]. Mortality data is most often used to assess the disease burden and there had been a 46% increase in CLD mortality in the world between 1980 to 2013, underscoring the emerging public health importance of CLD Most of this increase in CLD mortality has been reported from the low and low-middle income (LMIC) countries of Asia and Africa [3]. Clinical and vital events reporting in India is still fragmentary and usage of electronic medical records in hospitals is just beginning to take shape. In such a context of organized resources for meaningful data, policy framework suffers along with planning and allocation of resources. Each case was clinically assessed by a physician before enrollment
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