Increasing Cirrhosis Incidence in Young Birth Cohorts from 1997-2016: A Population-Based Study

Abstract

Background: Recent data shows the prevalence of chronic liver disease (CLD) and cirrhosis mortality is increasing in adolescents and young adults in the United States. We aimed to describe the epidemiology of cirrhosis using an Age-Period-Cohort (APC) approach to define birth cohort effects on cirrhosis incidence. Methods: Retrospective population-based cohort study in Ontario, Canada from January 1, 1997 - December 31, 2016 using linked administrative health data. Patients ≥ 18 years with cirrhosis were identified using a validated case definition. Annual standardized incidence rates (ASIR) and prevalence rates (ASPR) in the general population were calculated. An APC approach was used to assess the independent association between birth cohort and cirrhosis incidence. Findings: 165,979 individuals with cirrhosis were identified. The ASIR increased over the study (70.6/100,000 person-years 1997 vs. 89.6/100,000 in 2016) as did the prevalence (ASPR: 0.42% in 1997 vs. 0.84% in 2016). Using APC modeling and the median birth year as the reference, cirrhosis incidence was 55% higher if born in 1980 (IRR 1.55: 95% CI 1.50-1.59, P <.001); and 116% higher if born in 1990 (IRR 2.16: 95% CI 2.06-2.27, P <.001) compared to a person of the same age born in 1951. The cirrhosis incidence increase was greater in women than men. Interpretation: The incidence of cirrhosis has increased over two decades and more so in younger birth cohorts and in women. Given the cohort effects, this suggests that changes in the prevalence of CLD specific to each cohort are contributing. Future studies able to define the etiology and natural history of cirrhosis in these groups are essential to develop strategies that could reverse these trends for future generations. Funding: Funded by a Southeastern Ontario Academic Medical Association New Clinician Scientist Award (JAF). Declaration of Interest: There are no conflicts of interest to declare for this manuscript (JAF, YD, JMM, JS, PG, CMB). Ethical Approval: This study was approved by the Queen’s University Health Sciences Research Ethics Board (DMED-1651-13).