Mortality attributable to cholestatic liver disease in the United States†

Abstract

In the past 2 decades, important advances have been made in the treatment of cholestatic liver diseases, including primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Whether these new therapies have had demonstrable impact on mortality on a population-wide scale has not been evaluated. This study describes the age-specific and sex-specific mortality rates from PBC and PSC in the United States between 1980 and 1998, based on the Multiple Cause of Death files. Age-specific and sex- specific mortality rates from PBC and PSC were calculated. The multivariable Poisson model was used to evaluate temporal changes in mortality rates. In 1998, the total age-adjusted and sex-adjusted PBC-related mortality rate was 0.24 per 100,000, and the age-adjusted and sex-adjusted PSC-related mortality rate was 0.23 per 100,000. During the observation period, PBC-related mortality significantly decreased over time in women younger than 65 years, and in men of all age groups, whereas in older women this number increased over time. PSC-related mortality remained essentially stable, except in men 65 years of age or older. Since the early 1980s, significant changes in mortality from PBC have occurred. The most noticeable change was an increase in the age of death, which indicates prolongation of survival. These changes may be attributable to liver transplantation or ursodeoxycholic acid. In contrast, mortality from PSC remained largely unchanged, highlighting the need for more effective therapeutic strategies.