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Review
. 2023 Jun;20(6):388-398.
doi: 10.1038/s41575-023-00759-2. Epub 2023 Mar 28.

Global epidemiology of cirrhosis - aetiology, trends and predictions

Daniel Q Huang  1   2   3 , Norah A Terrault  4 , Frank Tacke  5 , Lise Lotte Gluud  6   7 , Marco Arrese  8   9 , Elisabetta Bugianesi  10 , Rohit Loomba  11   12
Affiliations
Review

Global epidemiology of cirrhosis - aetiology, trends and predictions

Daniel Q Huang et al. Nat Rev Gastroenterol Hepatol. 2023 Jun.

Abstract

Cirrhosis is an important cause of morbidity and mortality in people with chronic liver disease worldwide. In 2019, cirrhosis was associated with 2.4% of global deaths. Owing to the rising prevalence of obesity and increased alcohol consumption on the one hand, and improvements in the management of hepatitis B virus and hepatitis C virus infections on the other, the epidemiology and burden of cirrhosis are changing. In this Review, we highlight global trends in the epidemiology of cirrhosis, discuss the contributions of various aetiologies of liver disease, examine projections for the burden of cirrhosis, and suggest future directions to tackle this condition. Although viral hepatitis remains the leading cause of cirrhosis worldwide, the prevalence of non-alcoholic fatty liver disease (NAFLD) and alcohol-associated cirrhosis are rising in several regions of the world. The global number of deaths from cirrhosis increased between 2012 and 2017, but age-standardized death rates (ASDRs) declined. However, the ASDR for NAFLD-associated cirrhosis increased over this period, whereas ASDRs for other aetiologies of cirrhosis declined. The number of deaths from cirrhosis is projected to increase in the next decade. For these reasons, greater efforts are required to facilitate primary prevention, early detection and treatment of liver disease, and to improve access to care.

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Conflict of interest statement

D.Q.H. has served as an advisory board member for Eisai and Gilead. N.A.T. receives institutional grant support from DURECT Corporation, Eiger Pharmaceuticals, Gilead Sciences, Glaxo-Smith-Kline, Helio Health and Roche-Genentech. F.T. serves as a consultant to Abbvie, Alnylam, Boehringer-Ingelheim, CSL Behring, Falk, Gilead, Intercept, Inventiva, Ionis, Novartis, Novo Nordisk and Pfizer. His institute has received research grants from Allergan, Bristol Myers Squibb, Gilead and Inventiva. L.L.G. serves as a consultant to Novo Nordisk and Pfizer, and her institutes have received research grants from Alexion, Gilead, Novo Nordisk, Sobi Int. and Vingmed. M.A. receives support from the Chilean government through the Fondo Nacional De Ciencia y Tecnología de Chile (FONDECYT no. 1191145) and the Comisión Nacional de Investigación, Ciencia y Tecnología (CONICYT, AFB170005, CARE, Chile, UC). E.B. serves as a consultant to AstraZeneca, Boehringer-Ingelheim, Eli Lilly, Gilead, Intercept, Inventiva, Novartis, Novo Nordisk, Merck, MSD and Pfizer. Her institute has received a research grant from Gilead. R.L. serves as a consultant to 89 Bio, Aardvark Therapeutics, Altimmune, Anylam/Regeneron, Amgen, Arrowhead Pharmaceuticals, AstraZeneca, Bristol Myers Squibb, CohBar, Eli Lilly, Galmed, Gilead, Glympse bio, Hightide, Inipharma, Intercept, Inventiva, Ionis, Janssen, Madrigal, Metacrine, NGM Biopharmaceuticals, Novartis, Novo Nordisk, Merck, Pfizer, Sagimet, Theratechnologies, Terns Pharmaceuticals and Viking Therapeutics. In addition his institutes have received research grants from Arrowhead Pharmaceuticals, Astrazeneca, Boehringer-Ingelheim, Bristol Myers Squibb, Eli Lilly, Galectin Therapeutics, Galmed Pharmaceuticals, Gilead, Intercept, Hanmi, Intercept, Inventiva, Ionis, Janssen, Madrigal Pharmaceuticals, Merck, NGM Biopharmaceuticals, Novo Nordisk, Merck, Pfizer, Sonic Incytes and Terns Pharmaceuticals. He is also a co-founder of LipoNexus.

Figures

Fig. 1
Fig. 1. Dominant reported aetiology of cirrhosis from 1993 to 2021.
Data were obtained from a systematic review of cirrhosis that included studies published during the period 1993–2021 (ref. ).
Fig. 2
Fig. 2. Estimated age-standardized death rates due to cirrhosis in 2019 by country.
Data for the age-standardized death rate in 2019 were estimated in the Global Burden of Disease Study 2019 and these data were obtained from the GBD Results Tool. Where data for countries or regions were unavailable, the Global Burden of Disease Study 2019 results depended on modelling and past trends, potentially resulting in discrepancies in the accuracy of the data.
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