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
Incidence
- The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
- In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
Prevalence
- In 2015, the prevalence of cirrhosis is approximately 270 per 100,000 individuals in the United States.
- Currently, approximately seventy percent of cirrhotic individuals are unaware of having liver disease and go undiagnosed.
- The prevalence of cirrhosis is higher in:
- Non-Hispanic blacks
- Individuals below the poverty line
- Mexican Americans
- Areas with high illiteracy rates
- Viral hepatitis (mainly hepatitis C) is responsible for more than half of the cases of cirrhosis in the United States.
- The cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.
- 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:
- most common cause of cirrhosis worldwide, especially South-East Asia, but is less common in the United States.
- Primary biliary cirrhosis:
- In some areas of the US and UK, the prevalence is as high as 1 in 4000.
- Non alcoholic fatty liver disease: [1][2][3]
- Alpha 1-antitrypsin deficiency:
- approximately 40 percent of adults with homozygosity of PIZZ have histologically significant liver injury and cirrhosis [4]
- Hepatopulmonary syndrome:
- Hepatopulmonary syndrome has a prevalence of 4-47% in cirrhotic patients.
- Portopulmonary hypertension:
- The prevalence of portopulmonary hypertension is 2% in patients with cirrhosis.
- Cirrhotic cardiomyopathy:
- The prevalence of cirrhotic cardiomyopathy is 50% in cirrhotic patients.
Case-fatality rate/Mortality rate
- The 10 year-mortality rate of cirrhosis is approximately 34- 66 percent, largely dependent on the cause of cirrhosis.
- In 2001, cirrhosis was the tenth leading cause of death amongst men and the twelfth leading cause of death amongst women in the United States.[5]
- In 2006, cirrhosis was the twelfth leading cause of all deaths in United States.[6]
Age
- Patients of all age groups may develop [disease name].
- The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
- [Disease name] commonly affects individuals younger than/older than [number of years] years of age.
- [Chronic disease name] is usually first diagnosed among [age group].
- [Acute disease name] commonly affects [age group].
Race
- There is no racial predilection to [disease name].
- [Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
Gender
- [Disease name] affects men and women equally.
- [Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
Region
- The majority of [disease name] cases are reported in [geographical region].
- [Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
Developed Countries
Developing Countries
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[7]
- 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.[8]
- 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.[9]
Race
- There is greater prevalence of cirrhosis in hispanics with hepatitis C infection than in caucasian or african american.[3]
References
- ↑ 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.
- ↑ 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.
- ↑ 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.,
- ↑ 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.