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Abstract Details
Global epidemiology of cirrhosis - aetiology, trends and predictions
Nat Rev Gastroenterol Hepatol. 2023 Mar 28;1-11.doi: 10.1038/s41575-023-00759-2. Online ahead of print.
1NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, San Diego, CA, USA.
2Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
3Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore.
4Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA.
5Department of Hepatology & Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
6Gastro Unit, Copenhagen University Hospital, Hvidovre, Denmark.
7Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
8Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
9Centro de Envejecimiento Y Regeneración (CARE), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.
10Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Turin, Italy.
11NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, San Diego, CA, USA. roloomba@ucsd.edu.
12Division of Epidemiology, Department of Family Medicine and Public Health, University of California at San Diego, San Diego, CA, USA. roloomba@ucsd.edu.
Abstract
Cirrhosis is an important cause of morbidity and mortality in people with chronic liver disease worldwide. In 2019, cirrhosis was associated with 2.4% of global deaths. Owing to the rising prevalence of obesity and increased alcohol consumption on the one hand, and improvements in the management of hepatitis B virus and hepatitis C virus infections on the other, the epidemiology and burden of cirrhosis are changing. In this Review, we highlight global trends in the epidemiology of cirrhosis, discuss the contributions of various aetiologies of liver disease, examine projections for the burden of cirrhosis, and suggest future directions to tackle this condition. Although viral hepatitis remains the leading cause of cirrhosis worldwide, the prevalence of non-alcoholic fatty liver disease (NAFLD) and alcohol-associated cirrhosis are rising in several regions of the world. The global number of deaths from cirrhosis increased between 2012 and 2017, but age-standardized death rates (ASDRs) declined. However, the ASDR for NAFLD-associated cirrhosis increased over this period, whereas ASDRs for other aetiologies of cirrhosis declined. The number of deaths from cirrhosis is projected to increase in the next decade. For these reasons, greater efforts are required to facilitate primary prevention, early detection and treatment of liver disease, and to improve access to care.