Burden of liver disease in the United States: Summary of a workshop

Kim, Woojin; Brown, Robert S.; Terrault, Norah A.; El–Serag, Hashem B.

doi:10.1053/jhep.2002.34734

Cited by 526 publications

(359 citation statements)

References 61 publications

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“…In general, cause-specific mortality is reflected poorly in death certificate data. Consistent with some authors' suggestions, 26,27 future analyses of CLD mortality and its causes should include viral hepatitis and sequelae of CLD deaths because of the narrow definition of CLD in ICD. Further studies are needed to evaluate the validity of estimates of the mortality burden from CLD generated from national mortality data and to characterize better the causes of CLD deaths.…”

Section: Discussionmentioning

confidence: 60%

Chronic liver disease mortality in the United States, 1990-1998

2004

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In 1998, chronic liver disease (CLD) was the tenth leading cause of death in the U.S. Alcohol and hepatitis C are thought to be important etiologies. However, traditional methods for calculating CLD mortality rates from death certificates may underestimate hepatitis Crelated CLD mortality. We studied patterns of CLD deaths reported from 1990 through 1998, using an expanded definition that included death certificates where CLD, viral hepatitis, or CLD-related sequelae were reported as the underlying cause. We calculated overall age-specific and age-adjusted mortality rates, and according to demographic characteristics and recorded causes, and evaluated trends using linear regression modeling. CLD mortality declined 5% overall from 1990 through 1994 (12.1 to 11.6/100,000; P ‫؍‬ 0.002), but remained unchanged from 1995 through 1998 (P ‫؍‬ 0.366). Decreases were similar for all causes except hepatitis C, for which rates increased 220% from 1993 to 1998 (0.57 to 1.67/100,000). Rates declined in all racial-ethnic groups except American Indians and Alaska Natives (AI/AN), among whom rates were unchanged. Of 30,933 CLD deaths in 1998, 39% were coded as alcohol related, 15% as hepatitis C, 4% as hepatitis B, and 44% had no recorded cause. Age-adjusted rates were higher among males (47.6/100,000) than females (32.2/100,000) and among Hispanics (19.1/100,000) compared with non-Hispanics (10.8/ 100,000). Rates among AI/AN (28.7/100,000) were more than twice those of African Americans and whites (12.9/100,000 and 11.5/100,000, respectively). In conclusion, 1998 CLD deaths and the proportion attributable to viral hepatitis increased by 23% and 19%, respectively, compared with traditional methods. Mortality declines of the early 1990s were not sustained after 1994. Large disparities in CLD mortality remain, particularly among Amer-

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Section: Discussionmentioning

confidence: 60%

Chronic liver disease mortality in the United States, 1990-1998

2004

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“…As the second leading gastrointestinal cause of death following colorectal cancer, cirrhosis accounts for an estimated 44,000 deaths, 150,000 acute care hospitalizations, and $1.1 billion in direct costs annually in the United States (1,2). Furthermore, these trends are expected to increase, based on an aging population, the growing epidemic of obesity and its complications (non-alcoholic fatty liver diseases, NAFLD), and the continued emergence of chronic liver diseases and its complications among individuals with long-standing chronic hepatitis C infection (3,4).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Hepatic Fibrosis With Magnetic Resonance Elastography

Yin

Talwalkar

Glaser

et al. 2007

Clinical Gastroenterology and Hepatology

855

809

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Background & Aims-Accurate detection of hepatic fibrosis is crucial for assessing prognosis and candidacy for treatment in patients with chronic liver disease. Magnetic Resonance (MR) Elastography, a technique for quantitatively assessing the mechanical properties of soft tissues, has previously been shown to have potential for non-invasively detecting liver fibrosis. The goal of this work was to obtain preliminary estimates of the sensitivity and specificity of the technique in diagnosing liver fibrosis, and to assess its potential for identifying patients who can potentially avoid biopsy.

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“…1 HCV leads to cirrhosis in up to 20% of those chronically infected 2 and is the primary indication for liver transplantation worldwide. 3 This economic burden is multiplied by the dramatic impact of HCV on health related quality of life (HRQOL) resulting from complications of advanced liver disease such as encephalopathy, variceal hemorrhage, ascites, and liver transplantation.…”

mentioning

confidence: 99%

“…In light of this shortcoming we performed a systematic review and quantitative assessment with the following objectives: (1) to identify and summarize the published literature pertaining to HRQOL in HCV; (2) to compare the HRQOL in patients with HCV versus healthy controls; (3) to compare the HRQOL in HCV patients achieving sustained virologic response (SVR) versus those without SVR; (4) to stratify HRQOL data in HCV by clinically-relevant anchors, including liver disease severity anchors and neurological, psychological, and social anchors; and (5) to establish the minimally clinically important HRQOL difference (MCID) in HCV. These data may provide the basis for appropriate sample size calculations in treatment trials, allow physicians to better monitor patient outcomes in clinical practice, and equip patients with the knowledge to better select between competing management strategies.…”

mentioning

confidence: 99%

Impact of hepatitis C on health related quality of life

et al. 2005

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Hepatitis C virus (HCV) diminishes health related quality of life (HRQOL), and it is now common to measure HRQOL in clinical trials. We sought to summarize the HRQOL data in HCV, and to establish the minimally clinically important difference (MCID) in HRQOL scores in HCV. We performed a systematic review to identify relevant studies, and converted HRQOL data from each study into clinically interpretable statistics. An expert panel used a modified Delphi technique to estimate the MCID in HCV. We found that patients with HCV scored lower than controls across all scales of the SF-36. Patients achieving sustained virological response (SVR) scored higher across all scales versus patients without SVR, especially in the physical health domains. HRQOL differences did not correspond with differences in liver histology or ALT levels. Based upon the published data, the expert panel C hronic hepatitis C virus (HCV) infection is a prevalent and expensive condition affecting 4 million people in the United States at a cost of over $700 million annually. 1 HCV leads to cirrhosis in up to 20% of those chronically infected 2 and is the primary indication for liver transplantation worldwide. 3 This economic burden is multiplied by the dramatic impact of HCV on health related quality of life (HRQOL) resulting from complications of advanced liver disease such as encephalopathy, variceal hemorrhage, ascites, and liver transplantation. 4-6 However, these end-stage complications are relatively rare compared with the vast majority of patients with HCV in the absence of clinically significant liver disease. Despite the previous consensus that this majority of patients has asymptomatic seropositivity, 7 evolving data now indicate that HCV itself may diminish HRQOL in the absence of advanced liver disease, [8][9][10][11][12][13][14][15][16][17][18][19][20] perhaps as a result of extrahepatic symptoms related to HCV, cognitive dysfunction related to HCV, or a negative synergy between HCV and comorbid psychosocial disorders. 10,21 As awareness grows of the HRQOL decrement from HCV and its clinical consequences, investigators have be- From the

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Burden of liver disease in the United States: Summary of a workshop

Cited by 526 publications

References 61 publications

Chronic liver disease mortality in the United States, 1990-1998

Chronic liver disease mortality in the United States, 1990-1998

Assessment of Hepatic Fibrosis With Magnetic Resonance Elastography

Impact of hepatitis C on health related quality of life

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