Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis
Liver cirrhosis is a major yet largely preventable and underappreciated cause of global health loss. Variations in cirrhosis mortality at the country level reflect differences in
Variations in cirrhosis mortality at the country level reflect differences in the prevalence of risk factors such as alcohol use and hepatitis B and C infection. The researchers estimated annual age-specific mortality from liver cirrhosis in 187 countries between 1980 and 2010.
Methodology
The researchers systematically collected vital registration and verbal autopsy data on liver cirrhosis mortality for the period 1980 to 2010. They corrected for misclassification of deaths, which included deaths attributed to improbable or nonfatal causes. The researchers used ensemble models to estimate liver cirrhosis mortality with uncertainty by age, sex, country, and year. They employed out-of-sample predictive validity to select the optimal model.
The study systematically collected vital registration and verbal autopsy data on liver cirrhosis mortality for the period 1980 to 2010.The researchers corrected for misclassification of deaths, which included deaths attributed to improbable or nonfatal causes. They used ensemble models to estimate liver cirrhosis mortality with uncertainty by age, sex, country, and year. We used out-of-sample predictive validity to select the optimal model.
Results
Global liver cirrhosis deaths increased from around 676,000 in 1980 to over 1 million in 2010 (about 2% of the global total).
Over the same period, the age-standardized cirrhosis mortality rate decreased by 22%. This was largely driven by decreasing cirrhosis mortality rates in China, the US, and countries in Western Europe.
In 2010, Egypt, followed by Moldova, had the highest age-standardized cirrhosis mortality rates, 72.7 and 71.2 deaths per 100,000, respectively, while Iceland had the lowest. In Egypt, almost one-fifth (18.1%) of all deaths in males 45 to 54 years old were due to liver cirrhosis.
Liver cirrhosis mortality in Mexico is the highest in Latin America.
In France and Italy, liver cirrhosis mortality fell by 50% to 60%; conversely, in the United Kingdom, mortality increased by about one-third.
Mortality from liver cirrhosis was also comparatively high in Central Asian countries, particularly Mongolia, Uzbekistan, and Kyrgyzstan, and in parts of sub-Saharan Africa, notably Gabon.
Conclusions
Liver cirrhosis is a significant cause of global health burden, with more than one million deaths in 2010. The study identifies areas with high and/or rapidly increasing mortality where preventive measures to control and reduce liver cirrhosis risk factors should be urgently strengthened.