Abstract
Background: Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods: We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings: In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27–1·45) deaths (440 000 [416 000–518 000; 33·3%] in females and 883 000 [838 000–967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000–948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3–2·6) of total deaths globally in 2017 compared with 1·9% (1·8–2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2–22·3) per 100 000 population in 1990 to 16·5 (15·8–18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8–38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8–10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3–4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4–133·4] per 100 000 in 2017). There were 10·6 million (10·3–10·9) prevalent cases of decompensated cirrhosis and 112 million (107–119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation: Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. Funding: Bill & Melinda Gates Foundation.
Original language | English |
---|---|
Pages (from-to) | 245-266 |
Number of pages | 22 |
Journal | The Lancet Gastroenterology and Hepatology |
Volume | 5 |
Issue number | 3 |
DOIs | |
Publication status | Published - Mar 2020 |
ASJC Scopus subject areas
- Hepatology
- Gastroenterology
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The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017. / Sepanlou, Sadaf G.; Safiri, Saeid; Bisignano, Catherine; Ikuta, Kevin S.; Merat, Shahin; Saberifiroozi, Mehdi; Poustchi, Hossein; Tsoi, Derrick; Colombara, Danny V.; Abdoli, Amir; Adedoyin, Rufus Adesoji; Afarideh, Mohsen; Agrawal, Sutapa; Ahmad, Sohail; Ahmadian, Elham; Ahmadpour, Ehsan; Akinyemiju, Tomi; Akunna, Chisom Joyqueenet; Alipour, Vahid; Almasi-Hashiani, Amir; Almulhim, Abdulaziz M.; Al-Raddadi, Rajaa M.; Alvis-Guzman, Nelson; Anber, Nahla Hamed; Angus, Colin; Anoushiravani, Amir; Arabloo, Jalal; Araya, Ephrem Mebrahtu; Asmelash, Daniel; Ataeinia, Bahar; Ataro, Zerihun; Atout, Maha Moh d.Wahbi; Ausloos, Floriane; Awasthi, Ashish; Badawi, Alaa; Banach, Maciej; Bejarano Ramirez, Diana Fernanda; Bhagavathula, Akshaya Srikanth; Bhala, Neeraj; Bhattacharyya, Krittika; Biondi, Antonio; Bolla, Srinivasa Rao; Boloor, Archith; Borzì, Antonio M.; Butt, Zahid A.; Cámera, Luis LA Alberto; Campos-Nonato, Ismael R.; Carvalho, Félix; Chu, Dinh Toi; Chung, Sheng Chia; Cortesi, Paolo Angelo; Costa, Vera M.; Cowie, Benjamin C.; Daryani, Ahmad; de Courten, Barbora; Demoz, Gebre Teklemariam; Desai, Rupak; Dharmaratne, Samath Dhamminda; Djalalinia, Shirin; Do, Hoa Thi; Dorostkar, Fariba; Drake, Thomas M.; Dubey, Manisha; Duncan, Bruce B.; Effiong, Andem; Eftekhari, Aziz; Elsharkawy, Aisha; Etemadi, Arash; Farahmand, Mohammad; Farzadfar, Farshad; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Gebremedhin, Ketema Bizuwork Bizuwork; Geta, Birhanu; Gilani, Syed Amir; Gill, Paramjit Singh; Gutirrez, Reyna Alma; Haile, Michael Tamene; Haj-Mirzaian, Arvin; Hamid, Saeed S.; Hasankhani, Milad; Hasanzadeh, Amir; Hashemian, Maryam; Hassen, Hamid Yimam; Hay, Simon I.; Hayat, Khezar; Heidari, Behnam; Henok, Andualem; Hoang, Chi Linh; Hostiuc, Mihaela; Hostiuc, Sorin; Hsieh, Vivian Chia rong; Igumbor, Ehimario U.; Ilesanmi, Olayinka Stephen; Irvani, Seyed Sina Naghibi; Jafari Balalami, Nader; James, Spencer L.; Jeemon, Panniyammakal; Jha, Ravi Prakash; Jonas, Jost B.; Jozwiak, Jacek Jerzy; Kabir, Ali; Kasaeian, Amir; Kassaye, Hagazi Gebremedhin; Kefale, Adane Teshome; Khalilov, Rovshan; Khan, Muhammad Ali; Khan, Ejaz Ahmad; Khater, Amir; Kim, Yun Jin; Koyanagi, Ai; La Vecchia, Carlo; Lim, Lee Ling; Lopez, Alan D.; Lorkowski, Stefan; Lotufo, Paulo A.; Lozano, Rafael; Magdy Abd El Razek, Muhammed; Mai, Hue Thi; Manafi, Navid; Manafi, Amir; Mansournia, Mohammad Ali; Mantovani, Lorenzo Giovanni; Mazzaglia, Giampiero; Mehta, Dhruv; Mendoza, Walter; Menezes, Ritesh G.; Mengesha, Melkamu Merid; Meretoja, Tuomo J.; Mestrovic, Tomislav; Miazgowski, Bartosz; Miller, Ted R.; Mirrakhimov, Erkin M.; Mithra, Prasanna; Moazen, Babak; Moghadaszadeh, Masoud; Mohammadian-Hafshejani, Abdollah; Mohammed, Shafiu; Mokdad, Ali H.; Montero-Zamora, Pablo A.; Moradi, Ghobad; Naimzada, Mukhammad David; Nayak, Vinod; Negoi, Ionut; Nguyen, Trang Huyen; Ofori-Asenso, Richard; Oh, In Hwan; Olagunju, Tinuke O.; Padubidri, Jagadish Rao; Pakshir, Keyvan; Pana, Adrian; Pathak, Mona; Pourshams, Akram; Rabiee, Navid; Radfar, Amir; Rafiei, Alireza; Ramezanzadeh, Kiana; Rana, Saleem Muhammad M.; Rawaf, Salman; Rawaf, David Laith; Reiner, Robert C.; Roever, Leonardo; Room, Robin; Roshandel, Gholamreza; Safari, Saeed; Samy, Abdallah M.; Sanabria, Juan; Sartorius, Benn; Schmidt, Maria Inês; Senthilkumaran, Subramanian; Shaikh, Masood Ali; Sharif, Mehdi; Sharifi, Amrollah; Shigematsu, Mika; Singh, Jasvinder A.; Soheili, Amin; Suleria, Hafiz Ansar Rasul; Teklehaimanot, Berhane Fseha; Tesfay, Berhe Etsay; Vacante, Marco; Vahedian-Azimi, Amir; Valdez, Pascual R.; Vasankari, Tommi Juhani; Vu, Giang Thu; Waheed, Yasir; Weldegwergs, Kidu Gidey; Werdecker, Andrea; Westerman, Ronny; Wondafrash, Dawit Zewdu; Wondmieneh, Adam Belay; Yeshitila, Yordanos Gizachew; Yonemoto, Naohiro; Yu, Chuanhua; Zaidi, Zoubida; Zarghi, Afshin; Zelber-Sagi, Shira; Zewdie, Kaleab Alemayehu; Zhang, Zhi Jiang; Zhao, Xiu Ju; Naghavi, Mohsen; Malekzadeh, Reza.
In: The Lancet Gastroenterology and Hepatology, Vol. 5, No. 3, 03.2020, p. 245-266.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017
T2 - a systematic analysis for the Global Burden of Disease Study 2017
AU - Sepanlou, Sadaf G.
AU - Safiri, Saeid
AU - Bisignano, Catherine
AU - Ikuta, Kevin S.
AU - Merat, Shahin
AU - Saberifiroozi, Mehdi
AU - Poustchi, Hossein
AU - Tsoi, Derrick
AU - Colombara, Danny V.
AU - Abdoli, Amir
AU - Adedoyin, Rufus Adesoji
AU - Afarideh, Mohsen
AU - Agrawal, Sutapa
AU - Ahmad, Sohail
AU - Ahmadian, Elham
AU - Ahmadpour, Ehsan
AU - Akinyemiju, Tomi
AU - Akunna, Chisom Joyqueenet
AU - Alipour, Vahid
AU - Almasi-Hashiani, Amir
AU - Almulhim, Abdulaziz M.
AU - Al-Raddadi, Rajaa M.
AU - Alvis-Guzman, Nelson
AU - Anber, Nahla Hamed
AU - Angus, Colin
AU - Anoushiravani, Amir
AU - Arabloo, Jalal
AU - Araya, Ephrem Mebrahtu
AU - Asmelash, Daniel
AU - Ataeinia, Bahar
AU - Ataro, Zerihun
AU - Atout, Maha Moh d.Wahbi
AU - Ausloos, Floriane
AU - Awasthi, Ashish
AU - Badawi, Alaa
AU - Banach, Maciej
AU - Bejarano Ramirez, Diana Fernanda
AU - Bhagavathula, Akshaya Srikanth
AU - Bhala, Neeraj
AU - Bhattacharyya, Krittika
AU - Biondi, Antonio
AU - Bolla, Srinivasa Rao
AU - Boloor, Archith
AU - Borzì, Antonio M.
AU - Butt, Zahid A.
AU - Cámera, Luis LA Alberto
AU - Campos-Nonato, Ismael R.
AU - Carvalho, Félix
AU - Chu, Dinh Toi
AU - Chung, Sheng Chia
AU - Cortesi, Paolo Angelo
AU - Costa, Vera M.
AU - Cowie, Benjamin C.
AU - Daryani, Ahmad
AU - de Courten, Barbora
AU - Demoz, Gebre Teklemariam
AU - Desai, Rupak
AU - Dharmaratne, Samath Dhamminda
AU - Djalalinia, Shirin
AU - Do, Hoa Thi
AU - Dorostkar, Fariba
AU - Drake, Thomas M.
AU - Dubey, Manisha
AU - Duncan, Bruce B.
AU - Effiong, Andem
AU - Eftekhari, Aziz
AU - Elsharkawy, Aisha
AU - Etemadi, Arash
AU - Farahmand, Mohammad
AU - Farzadfar, Farshad
AU - Fernandes, Eduarda
AU - Filip, Irina
AU - Fischer, Florian
AU - Gebremedhin, Ketema Bizuwork Bizuwork
AU - Geta, Birhanu
AU - Gilani, Syed Amir
AU - Gill, Paramjit Singh
AU - Gutirrez, Reyna Alma
AU - Haile, Michael Tamene
AU - Haj-Mirzaian, Arvin
AU - Hamid, Saeed S.
AU - Hasankhani, Milad
AU - Hasanzadeh, Amir
AU - Hashemian, Maryam
AU - Hassen, Hamid Yimam
AU - Hay, Simon I.
AU - Hayat, Khezar
AU - Heidari, Behnam
AU - Henok, Andualem
AU - Hoang, Chi Linh
AU - Hostiuc, Mihaela
AU - Hostiuc, Sorin
AU - Hsieh, Vivian Chia rong
AU - Igumbor, Ehimario U.
AU - Ilesanmi, Olayinka Stephen
AU - Irvani, Seyed Sina Naghibi
AU - Jafari Balalami, Nader
AU - James, Spencer L.
AU - Jeemon, Panniyammakal
AU - Jha, Ravi Prakash
AU - Jonas, Jost B.
AU - Jozwiak, Jacek Jerzy
AU - Kabir, Ali
AU - Kasaeian, Amir
AU - Kassaye, Hagazi Gebremedhin
AU - Kefale, Adane Teshome
AU - Khalilov, Rovshan
AU - Khan, Muhammad Ali
AU - Khan, Ejaz Ahmad
AU - Khater, Amir
AU - Kim, Yun Jin
AU - Koyanagi, Ai
AU - La Vecchia, Carlo
AU - Lim, Lee Ling
AU - Lopez, Alan D.
AU - Lorkowski, Stefan
AU - Lotufo, Paulo A.
AU - Lozano, Rafael
AU - Magdy Abd El Razek, Muhammed
AU - Mai, Hue Thi
AU - Manafi, Navid
AU - Manafi, Amir
AU - Mansournia, Mohammad Ali
AU - Mantovani, Lorenzo Giovanni
AU - Mazzaglia, Giampiero
AU - Mehta, Dhruv
AU - Mendoza, Walter
AU - Menezes, Ritesh G.
AU - Mengesha, Melkamu Merid
AU - Meretoja, Tuomo J.
AU - Mestrovic, Tomislav
AU - Miazgowski, Bartosz
AU - Miller, Ted R.
AU - Mirrakhimov, Erkin M.
AU - Mithra, Prasanna
AU - Moazen, Babak
AU - Moghadaszadeh, Masoud
AU - Mohammadian-Hafshejani, Abdollah
AU - Mohammed, Shafiu
AU - Mokdad, Ali H.
AU - Montero-Zamora, Pablo A.
AU - Moradi, Ghobad
AU - Naimzada, Mukhammad David
AU - Nayak, Vinod
AU - Negoi, Ionut
AU - Nguyen, Trang Huyen
AU - Ofori-Asenso, Richard
AU - Oh, In Hwan
AU - Olagunju, Tinuke O.
AU - Padubidri, Jagadish Rao
AU - Pakshir, Keyvan
AU - Pana, Adrian
AU - Pathak, Mona
AU - Pourshams, Akram
AU - Rabiee, Navid
AU - Radfar, Amir
AU - Rafiei, Alireza
AU - Ramezanzadeh, Kiana
AU - Rana, Saleem Muhammad M.
AU - Rawaf, Salman
AU - Rawaf, David Laith
AU - Reiner, Robert C.
AU - Roever, Leonardo
AU - Room, Robin
AU - Roshandel, Gholamreza
AU - Safari, Saeed
AU - Samy, Abdallah M.
AU - Sanabria, Juan
AU - Sartorius, Benn
AU - Schmidt, Maria Inês
AU - Senthilkumaran, Subramanian
AU - Shaikh, Masood Ali
AU - Sharif, Mehdi
AU - Sharifi, Amrollah
AU - Shigematsu, Mika
AU - Singh, Jasvinder A.
AU - Soheili, Amin
AU - Suleria, Hafiz Ansar Rasul
AU - Teklehaimanot, Berhane Fseha
AU - Tesfay, Berhe Etsay
AU - Vacante, Marco
AU - Vahedian-Azimi, Amir
AU - Valdez, Pascual R.
AU - Vasankari, Tommi Juhani
AU - Vu, Giang Thu
AU - Waheed, Yasir
AU - Weldegwergs, Kidu Gidey
AU - Werdecker, Andrea
AU - Westerman, Ronny
AU - Wondafrash, Dawit Zewdu
AU - Wondmieneh, Adam Belay
AU - Yeshitila, Yordanos Gizachew
AU - Yonemoto, Naohiro
AU - Yu, Chuanhua
AU - Zaidi, Zoubida
AU - Zarghi, Afshin
AU - Zelber-Sagi, Shira
AU - Zewdie, Kaleab Alemayehu
AU - Zhang, Zhi Jiang
AU - Zhao, Xiu Ju
AU - Naghavi, Mohsen
AU - Malekzadeh, Reza
N1 - Funding Information: SLJ reports grants from Sanofi Pasteur, outside the submitted work. PJ reports receiving the Wellcome Trust/DBT India Alliance Fellowship [grant number IA/CPHI/14/1/501497]. JJJ reports personal fees from Alab Laboratoria and Teva Polska, and non-financial support from Servier, Microlife, Superpharm, and Medicover, outside the submitted work. SL reports personal fees from Akcea Therapeutics, Amgen, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo, MSD Sharp & Dohme, Novo Nordisk, Sanofi-Aventis, Synlab, Unilever, and Upfield, as well as non-financial support from Preventicus outside the submitted work. PAL reports grants from Fundação Vale, Rio de Janeiro, Brazil. JAS is on the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives funding from 12 pharmaceutical companies, serves on the FDA Arthritis Advisory Committee, is a member of the Veterans Affairs Rheumatology Field Advisory Committee, is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, is on the speaker's bureau of Simply Speaking, consults with Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Spherix, Practice Point communications, the National Institutes of Health and the American College of Rheumatology, and has stock options in Amarin Pharmaceuticals and Viking Pharmaceuticals. All other authors declare no competing interests. Funding Information: This study is funded by the Bill & Melinda Gates Foundation . AB is supported by the Public Health Agency of Canada . LAC acknowledges the Argentine Society of Medicine for supporting our research. FC acknowledges support through Portuguese national funds ( UID/MULTI/04378/2019 and UID/QUI/50006/2019 with FCT/MCTES). VMC acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundaco para a Ciencia e Tecnologia (FCT), IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. SLJ works on an influenza/RSV grant funded by Sanofi Pasteur. PJ is supported by Wellcome Trust/DBT India Alliance Fellowship [grant number IA/CPHI/14/1/501497]. YJK acknowledges support from Xiamen University Malaysia Research Fund (Grant No. XMUMRF/2018-2/ITCM/0001 ). SL acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). WM is currently Program Analyst Population and Development at the United Nations Population Fund-UNFPA Country Office in Peru, which not necessarily endorses this study. PM-Z acknowledges the support awarded in 2015 by the National Council of Science and Technology of Mexico, the Inter-American Development Bank, the Organization of American States, and the National Council for Scientific and Technological Research of Costa Rica for offering them a postgraduate scholarship to be able to participate in the Global Burden of Disease technical training celebrated in Greece. AMS was supported by a fellowship from the Egyptian Fulbright Mission Program (EFMP).
PY - 2020/3
Y1 - 2020/3
N2 - Background: Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods: We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings: In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27–1·45) deaths (440 000 [416 000–518 000; 33·3%] in females and 883 000 [838 000–967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000–948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3–2·6) of total deaths globally in 2017 compared with 1·9% (1·8–2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2–22·3) per 100 000 population in 1990 to 16·5 (15·8–18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8–38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8–10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3–4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4–133·4] per 100 000 in 2017). There were 10·6 million (10·3–10·9) prevalent cases of decompensated cirrhosis and 112 million (107–119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation: Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. Funding: Bill & Melinda Gates Foundation.
AB - Background: Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods: We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings: In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27–1·45) deaths (440 000 [416 000–518 000; 33·3%] in females and 883 000 [838 000–967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000–948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3–2·6) of total deaths globally in 2017 compared with 1·9% (1·8–2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2–22·3) per 100 000 population in 1990 to 16·5 (15·8–18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8–38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8–10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3–4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4–133·4] per 100 000 in 2017). There were 10·6 million (10·3–10·9) prevalent cases of decompensated cirrhosis and 112 million (107–119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation: Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. Funding: Bill & Melinda Gates Foundation.
UR - http://www.scopus.com/inward/record.url?scp=85079434288&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85079434288&partnerID=8YFLogxK
U2 - 10.1016/S2468-1253(19)30349-8
DO - 10.1016/S2468-1253(19)30349-8
M3 - Article
C2 - 31981519
AN - SCOPUS:85079434288
VL - 5
SP - 245
EP - 266
JO - The Lancet Gastroenterology and Hepatology
JF - The Lancet Gastroenterology and Hepatology
SN - 2468-1253
IS - 3
ER -