Cirrhosis: It’s not just for heavy drinkers anymore

By Amy VanderZanden, special to Humanosphere

More people around the world are dying from cirrhosis of the liver than ever before, according to a new study on global causes of death published this week as part of an ongoing project known as the Global Burden of Disease (or GBD, for short).

The GBD researchers, who this year focused on mortality trends between 1990 and 2013, discovered that cirrhosis as a cause of death – which has seldom received much attention as a leading killer – is on the increase even as global interventions targeting infectious diseases have produced major reductions in mortality from some of the more high-profile deadly diseases such as AIDS, malaria or TB.

Cirrhosis killed 838,000 people worldwide in 1990. By 2013 there were nearly twice as many deaths – over 1.2 million people died from cirrhosis last year, a 45% increase over the two decades. These deaths are climbing at the same time that deaths from infectious diseases are falling substantially. In many countries and regions, the burden of cirrhosis is actually quite low, but a few parts of the world are substantially affected by this deadly disease.

Often thought of as a disease caused by alcoholism, the burden of cirrhosis is increasingly related to hepatitis. Over 50% of global cirrhosis deaths in 2013 were the result of hepatitis B or C infection, while just under a third of deaths were the result of cirrhosis from alcohol use.

Cirrhosis is a condition caused by the buildup of scar tissue in a liver weakened by chronic or long-lasting injury. Gone untreated, the liver slowly deteriorates until it fails, which can be fatal. In 1990, cirrhosis ranked 18th globally for most premature deaths; by 2013 it had climbed to 13th – above lung cancer and diabetes.

While cirrhosis has long been a leading cause of premature death and mortality in places like Western Europe and Russia, much of the growth of its burden in the last 20 years has been in other regions of the world. For men in Eastern Europe, Central Asia, and Egypt, cirrhosis is a major contributor to premature death, especially among reproductive-aged men (ages 15-49).

Probability of death from cirrhosis among 15-49 year olds, 2013

Cirrhosis GBD

Notes: Source: Global Burden of Disease Study 2013. To explore the data visualization online, go to http://vizhub.healthdata.org/le/

Looking at a map that shows the probability of death from cirrhosis among males and females of reproductive age, we see that the distribution of cirrhosis deaths is widely varied, with particularly high likelihood of death in countries such as Egypt, Mexico, Mongolia, and Myanmar.

Since 1990, the number of deaths from cirrhosis secondary to hepatitis C has increased more than twice as quickly as cirrhosis due to alcohol use. While the burden of alcohol-related cirrhosis deaths is especially elevated in Mexico and western Latin America, hepatitis-related cirrhosis is a particular burden in Central and South Asia.

In Egypt, mortality from cirrhosis secondary to hepatitis C is particularly high, especially among men and women over the age of 50, in part because of widespread infection in the 1960s after a mass schistosomiasis treatment campaign that used contaminated needles. There were twice as many deaths per 100,000 Egyptians aged 50-69 than in Moldova, which had the second-highest death rate from cirrhosis caused by hepatitis C for that age group in 2013. Nearly 10% of global cirrhosis deaths caused by hepatitis C in 2013 were in Egypt – a country responsible for just over 1% of the global population.

Probability of death among 15-49 year olds in high-cirrhosis-burden regions, 2013

Cirrhosis IHME 2

Notes: Source: Global Burden of Disease Study 2013. To explore the data visualization online, go to http://vizhub.healthdata.org/le/

While overall death rates for cirrhosis of the liver have declined somewhat since 1990, death rates for cirrhosis caused by hepatitis C have barely decreased, and the total number of deaths due to cirrhosis continues to increase.

By and large, cirrhosis deaths are preventable – by avoiding the risk factors that can lead to hepatitis (including unprotected sex and needle sharing) and limiting alcohol consumption to a moderate amount, populations could significantly decrease the risk of cirrhosis.

Amy VanderZanden is a communications data specialist at the University of Washington’s Institute for Health Metrics and Evaluation (IHME). Amy VanderZanden

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