The Burden of Liver Cirrhosis and Underlying Etiologies: Results from the Global Burden of Disease Study 2017

Abstract

Background: Liver cirrhosis is a major health issues throughout the world and is characterized as the end-stage of chronic liver disease. The etiologies of liver cirrhosis including hepatitis, alcohol, NASH and other causes, but rare study explored the prevalence trend of liver cirrhosis caused by specific etiologies. Aiming to study the pattern and prevalence trend of liver cirrhosis, we conducted the study. Methods: Based on the Global Burden of Disease 2017, we collected detailed data of liver cirrhosis during the period from 1990 to 2017. Age standardized prevalence rate (ASR) and estimated annual percentage changes (EAPC) were used to estimate the trend of liver cirrhosis prevalence by population, etiology and region. Findings: Globally, the prevalence cases of liver cirrhosis increased 74.55% from 1990 to 2017. The worldwide ASR of liver cirrhosis increase 0.75 per year during the period. Among the etiologies, NASH caused liver cirrhosis accounted for 59.46% in 2017. The ASR of liver cirrhosis caused by NASH increased 1.74 per year all over the world during the period. Additionally, the ASR of liver cirrhosis caused by NASH increased in 195 countries and territories and in all 5 SDI regions. Besides, the ASR of liver cirrhosis caused by alcohol use also increased. Contrary, the ASR of liver cirrhosis caused by HBV and HCV decreased. The ASR of liver cirrhosis caused by other causes remained stable during the same period. The increasing pattern was heterogeneous across regions and countries. The most pronounced increases were found in middle-high and high SDI regions, especially in Caribbean, Andean Latin America and Southern Latin America. Interpretation: By using vaccine and direct-acting antiviral therapy, the number of people suffered HBV and HCV decreased, but liver cirrhosis still confirmed to be a major threat to human health. Additionally, the number of people with cirrhosis caused by alcohol use and NASH continues to grow. Thus, more target and specific strategies should be established in various countries based on the etiology and prevalence trend of liver cirrhosis. Funding: This study was supported by the Hunan Provincial Natural Science Foundation of China (No. 2018JJ3715 and No. 2017JJ3448). Declaration of Interest: The authors declare no conflicts of interest. Ethical Approval: Not required.