Cirrhosis epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Overview
The most common cause of cirrhosis in the United States is chronic and heavy alcohol use, while the most common cause of cirrhosis worldwide is the hepatitis virus. Cirrhosis and chronic liver disease is the 12th leading cause of death in United States.
Epidemiology and Demographics
Prevalence
- Cirrhosis and chronic liver disease were the 10th leading cause of death for men and the 12th for women in the United States in 2001, killing about 27,000 people each year.[1] Also, the cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.
- Cirrhosis and chronic liver disease were the 12th leading cause of deaths in United States in 2006.[2]
- Established cirrhosis has a 10-year mortality of 34-66%, largely dependent on the cause of the cirrhosis; alcoholic cirrhosis has a worse prognosis than primary biliary cirrhosis and cirrhosis due to hepatitis. The risk of death due to all causes is increased twelvefold; if one excludes the direct consequences of the liver disease, there is still a fivefold increased risk of death in all disease categories.[3]
- Hospital Inpatient Care: Number of discharges with chronic liver disease or cirrhosis as the first-listed diagnosis: 101,000[3]
- Mortality due to cirrhosis and chronic liver disease in US:
- Number of deaths: 30,558
- Deaths per 100,000 population: 10.0[4]
- Alcoholic cirrhosis: Alcoholic cirrhosis develops in 15% of individuals who drink heavily for more than a decade. There is great variability in the amount of alcohol needed to cause cirrhosis (as little as 3-4 drinks a day in some men and 2-3 in some women).
- Chronic hepatitis B: The hepatitis B virus is probably the most common cause of cirrhosis worldwide, especially South-East Asia, but it is less common in the United States and the Western world.
- Primary biliary cirrhosis: In some areas of the US and UK the prevalence is estimated to be as high as 1 in 4000.
- Non alcoholic fatty liver disease: Non alcoholic fatty liver disease, in turn, may progress to fibrosis and, later, cirrhosis. Studies of serial liver biopsies estimate a 26-37% rate of hepatic fibrosis and 2-15% rate of cirrhosis in less than 6 years. [4][5][6]
- Alpha1-antitrypsin deficiency: Approximately 40 percent of adults with PI*ZZ have histologically significant liver injury and cirrhosis [7]
Age
- Cirrhosis is infrequently seen in young adults.
Gender
- Primary biliary cirrhosis : Primary biliary cirrhosis is more common in women.
- Chronic Hepatitis C: Among those chronically infected, the risk of cirrhosis after 20 years varies between studies but has been estimated at ~10%-15% for men and ~1-5% for women. The reason for this difference is not known. Once cirrhosis is established, the rate of developing hepatocellular carcinoma is ~1%-4% per year[8]
- Non alcoholic fatty liver disease: Non-alcoholic fatty liver disease is also more common among men than women in all age groups until age 60, where the prevalence between sex equalize. This is due to the protective nature of estrogen.[9]
- Autoimmune hepatitis: Autoimmune hepatitis usually occurs in women (70 %) between the ages of 15 and 40.
- Alpha1-antitrypsin deficiency: Male gender and obesity may be risk factors for progression to advanced liver disease in adulthood among patients with severe AAT deficiency.[10]
Race
- There is greater prevalence of cirrhosis in hispanics with hepatitis C infection than in caucasian or african american.[5]
References
- ↑ Anderson RN, Smith BL. Deaths: leading causes for 2001. Natl Vital Stat Rep2003;52:1-85. PMID 14626726.
- ↑ Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B. Deaths: Final data for 2006. National vital statistics reports; vol 57 no 14. Hyattsville, MD: National Center for Health Statistics. 2009.
- ↑ Sorensen HT, Thulstrup AM, Mellemkjar L, Jepsen P, Christensen E, Olsen JH, Vilstrup H. Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark. J Clin Epidemiol2003;56:88-93. PMID 12589875.
- ↑ Adams LA, Sanderson S, Lindor KD, et al. The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J Hepatol 2005;42(1):132–8.
- ↑ Harrison SA, Torgerson S, Hayashi PH. The natural history of nonalcoholic fatty liver disease:a clinical histopathological study. Am J Gastroenterol 2003;98(9):2042–7.
- ↑ Ekstedt M, Franzén LE, Mathiesen UL, et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology 2006;44:865-73.
- ↑ Bals R (2010). "Alpha-1-antitrypsin deficiency". Best Pract Res Clin Gastroenterol. 24 (5): 629–33. doi:10.1016/j.bpg.2010.08.006. PMID 20955965. Unknown parameter
|month=ignored (help) - ↑ Yu ML, Chuang WL (2009). "Treatment of chronic hepatitis C in Asia: when East meets West". J. Gastroenterol. Hepatol. 24 (3): 336–45. doi:10.1111/j.1440-1746.2009.05789.x. PMID 19335784. Unknown parameter
|month=ignored (help), - ↑ Lobanova YS, Scherbakov AM, Shatskaya VA, Evteev VA, Krasil’nikov MA (2009). "NF- kappaB suppression provokes the sensitization of hormone-resistant breast cancer cells to estrogen apoptosis". Mol Cell Biochem. 324.
- ↑ Bowlus CL, Willner I, Zern MA; et al. (2005). "Factors associated with advanced liver disease in adults with alpha1-antitrypsin deficiency". Clin. Gastroenterol. Hepatol. 3 (4): 390–6. PMID 15822045. Unknown parameter
|month=ignored (help)