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] Sudarshana Datta, MD [3]
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 and in Asian countries is the hepatitis virus. The gender that is most commonly affected by cirrhosis varies, depending upon the etiology. The incidence of cirrhosis increases with age; the median age of diagnosis of cirrhosis due to alcoholic liver disease is 52 years. The median age of diagnosis of cryptogenic/NAFLD/NASH cirrhosis is 60 years.
Epidemiology and Demographics
Prevalence
- In 2015, the prevalence of cirrhosis was approximately 270 per 100,000 individuals in the United States.[1]
- 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
- Chronic and heavy alcohol use is responsible for more than half of the cases of cirrhosis in the United States.[1]
- The cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.
- The rate of developing hepatocellular carcinoma in cirrhotic patients is approximately 1%-4% per year.[2]
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).[3]
Chronic hepatitis B:
- Chronic hepatitis B is the 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 (NAFLD): [4][5][6]
Alpha 1-antitrypsin deficiency:
- Approximately 40 percent of adults with homozygosity of PIZZ have histologically significant liver injury and cirrhosis.[7]
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 among men and the twelfth leading cause of death among women in the United States.[8]
- In 2006, cirrhosis was the twelfth leading cause of all deaths in United States.[9]
Age
- Cirrhosis is infrequently seen in young adults.
- The incidence of cirrhosis increases with age; the median age at diagnosis of cirrhosis due to alcoholic liver disease is 52 years.[10]
- The median age of diagnosis of cryptogenic/NAFLD/NASH cirrhosis is 60 years.
- The median age of diagnosis of autoimmune cirrhosis is 43 years.
Race
- The prevalence of cirrhosis is higher in: [4][10]
- Non-Hispanic blacks
- Mexican Americans
- Hispanics with hepatitis C infection
Gender
- The gender that is most commonly affected by cirrhosis varies, depending on the underlying etiology.
Primary biliary cirrhosis:
- Primary biliary cirrhosis is more common in women.
Chronic Hepatitis C:
- The risk of cirrhosis after 20 years is estimated to be approximately 10%-15% for men and 1-5% for women.[2]
Non alcoholic fatty liver disease:
- Non-alcoholic fatty liver disease is more common among men than women in all age groups until age 60.
- At 60 years of age, the prevalence of cirrhosis in males and females equalizes, due to absence of the protective nature of estrogen.[11]
Autoimmune hepatitis:
- Autoimmune hepatitis usually occurs in women in seventy percent of cases 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.[12]
Developed Countries
- Chronic and heavy alcohol use is responsible for more than half of the cases of cirrhosis in the United States.
Developing Countries
- Chronic hepatitis B is the most common cause of cirrhosis worldwide, especially South-East Asia, but is less common in the United States.
References
- ↑ 1.0 1.1 Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, Volk ML (2015). "The Epidemiology of Cirrhosis in the United States: A Population-based Study". J. Clin. Gastroenterol. 49 (8): 690–6. doi:10.1097/MCG.0000000000000208. PMID 25291348.
- ↑ 2.0 2.1 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.,
- ↑ 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.
- ↑ 10.0 10.1 Sajja KC, Mohan DP, Rockey DC (2014). "Age and ethnicity in cirrhosis". J. Investig. Med. 62 (7): 920–6. doi:10.1097/JIM.0000000000000106. PMC 4172494. PMID 25203153.
- ↑ 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.