Abstract
BackgroundGlobally, the morbidity and mortality rates for chronic liver disease and cirrhosis are increasing. The National Viral Hepatitis Therapy Program in Taiwan was implemented in 2003, but evidence regarding the program’s effect on the trends of mortality for chronic liver disease and cirrhosis is limited.MethodsWe analyzed mortality rates for chronic liver disease and cirrhosis in Taiwan for the period from 1981 to 2015. An autoregressive age–period–cohort model was used to estimate age, period, and cohort effects.ResultsAge-adjusted mortality rates for chronic liver disease and cirrhosis all displayed a flat but variable trend from 1981 to 2004 and a decreasing trend thereafter for both sexes. The age–period–cohort model revealed differential age gradients between the two sexes; mortality rates in the oldest age group (90–94 years) were 12 and 66 times higher than those in the youngest age group (30–34 years) for men and women, respectively. The period effects indicated that mortality rates declined after 2004 in both sexes. Mortality rates decreased in men but increased in women in the 1891–1940 birth cohorts and increased in both sexes in the birth cohorts from 1950 onward.ConclusionsThe National Viral Hepatitis Therapy Program in Taiwan may have contributed to the decrease in mortality rates for chronic liver disease and cirrhosis in adulthood.
Highlights
The morbidity and mortality rates for chronic liver disease and cirrhosis are increasing
A likelihood ratio test was performed between the age–period–cohort model and the two-factor models to determine an appropriate model to fit the mortality data of chronic liver disease and cirrhosis
The trends observed for both sexes were similar, but the age-adjusted mortality rate in men was considerably higher than that in women
Summary
The data for men indicated that mortality rates for chronic liver disease and cirrhosis in the oldest age group (90–94 years) were approximately 20 times higher than those in the youngest age group (30–34 years) (Fig. 2A). The period trend for men (Fig. 2B) revealed that mortality rates increased from 1981 to 2000 and decreased after 2000 in the younger age groups (30–59 years). The data for women indicated that mortality rates for chronic liver disease and cirrhosis in the oldest age group (90–94 years) were approximately 80 times higher than those in the youngest age group (30–34 years) (Fig. 2D). The likelihood ratio test results indicate that all three temporal variables should be considered for both sexes when modeling mortality rates for chronic liver disease and cirrhosis. The cohort effect exhibited an increasing trend from 1891 to 1941, a suddenly decreasing trend from 1941 to 1951, and an increasing trend after 1951
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