Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis

Abstract

BACKGROUND & AIMS:Accurate estimates for the contemporary burden of chronic liver disease (CLD) are vital for setting clinical, research, and policy priorities. We aimed to review the incidence, prevalence, and mortality of CLD and its resulting complications, including cirrhosis and hepatocellular carcinoma (HCC). METHODS:We reviewed the published literature on the incidence, prevalence, trends of various etiologies of CLD and its resulting complications. In addition, we provided updated data from the Centers for Disease Control and Global Burden of Disease Study on the morbidity and mortality of CLD, cirrhosis, and hepatocellular carcinoma (HCC). Lastly, we assessed the strengths and weaknesses of available sources of data in hopes of providing important context to these national estimates of cirrhosis burden. RESULTS:An estimated 1.5 billion persons have CLD worldwide and the age-standardized incidence of CLD and cirrhosis is 20.7/100,000, a 13% increase since 2000. Similarly, cirrhosis prevalence and mortality has increased in recent years in the United States. The epidemiology of CLD is shifting, reflecting implementation of large-scale hepatitis B vaccination and hepatitis C treatment programs, the increasing prevalence of the metabolic syndrome, and increasing alcohol misuse. CONCLUSIONS:The global burden of CLD and cirrhosis is substantial. Although vaccination, screening, and antiviral treatment campaigns for hepatitis B and C have reduced the CLD burden in some parts of the world, concomitant increases in injection drug use, alcohol misuse, and metabolic syndrome threaten these trends. Ongoing efforts to address CLD-related morbidity and mortality require accurate contemporary estimates of epidemiology and outcomes.

Global Trends in Incidence Rates of Primary Adult Liver Cancers: A Systematic Review and Meta-Analysis

“…Reducing exposures to these risk factors is logically the most effective way to lower the risk of developing liver cancer, and this was reflected in the most commonly cited reasons for decreasing incidence rates being mass HBV immunization (30-34, 37, 42, 55, 57, 67), controlling HCV transmission (30,39,51,56), and efficacy of antiviral therapies for hepatitis infection (19, 27, 37-39, 56, 57, 62). New anti-HCV treatments widely available in Western countries offer effective cure of HCV even for patients with advanced liver disease and reduce HCC risk by ∼70% (76); however, their potential benefit has been hampered by lack of affordability and insurance coverage among certain population subgroups (73,75,77).…”

“…The latter include screening of high-risk populations (23,31,47,49,(51)(52)(53)61) and ensuring equitable access to curative therapies for HBV/HCV infections among all population subgroups (23,32,37,47,48,52,53,59). However, even if incidence of HCV-related HCC decreases in the future due to improved treatments and better control (75,81), this may be offset by the emerging etiological importance of NAFLD as a key risk factor (77,82). The latter reflects the continuing increase in the global prevalence of obesity (83,84) and diabetes (84,85), two well-established risk factors for NAFLD (86).…”

Are Liver Pericytes Just Precursors of Myofibroblasts in Hepatic Diseases? Insights from the Crosstalk between Perivascular and Inflammatory Cells in Liver Injury and Repair

“…Hepatocyte injury (1) causes release of damage-associated molecular patterns, DAMPs (2). These DAMPs lead to Kupffer cell activation (3) and consequent release of inflammatory mediators (4). Kupffer cells can also be activated by pathogen-associated molecular patterns (PAMPs) derived from pathogenic bacteria or viruses (2 ).…”

“…It is estimated that approximately two million deaths per year worldwide are due to liver diseases, including cirrhosis, viral hepatitis, and liver cancer [1]. Although accurate incidence, prevalence, and mortality data are not available for a large number of countries, recent reviews have shown that vaccination, screening, and antiviral treatment campaigns have reduced the disease burden in some regions of the world [2,3]. However, increased use of injection drugs and alcohol, changes in diet and life habits, as well as prevalence of obesity and diabetes, tend to further increase the global burden of acute and chronic liver disease.…”

Comprehensive Health‐State Utilities in Contemporary Patients With Cirrhosis

“…(6) Unfortunately, published utilities may not accurately represent contemporary persons with cirrhosis. The epidemiology of cirrhosis has shifted, now characterized by aging persons with nonalcoholic fatty liver disease (NAFLD), alcoholrelated disease, or treated hepatitis C. (7) Cost-effectiveness analyses depend on generalizable utilities but continue to use extremely dated values that are often more than 20 years old and derived from patients with viremic hepatitis C, few of whom had decompensated cirrhosis and few of which capture the contribution of specific cirrhosis symptoms. (8)(9)(10)(11) Updated heath-state utilities are therefore needed in order to execute meaningful cost-effectiveness studies that represent contemporary patients.…”