Changes in the Global Burden of Chronic Liver Diseases From ... : Hepatology (original) (raw)

Original Articles: Steatohepatitis/Metabolic Liver Disease

Changes in the Global Burden of Chronic Liver Diseases From 2012 to 2017: The Growing Impact of NAFLD

Paik, James M.1; Golabi, Pegah1; Younossi, Youssef2; Mishra, Alita3; Younossi, Zobair M.*,1,3

1Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchVAUnited States

2Center for Outcomes Research in Liver DiseasesWashingtonDCUnited States

3Center for Liver DiseaseDepartment of MedicineInova Fairfax Medical CampusFalls ChurchVA

* Address Correspondence and Reprint Requests to:
Zobair M. Younossi, M.D., M.P.H.
Betty and Guy Beatty Center for Integrated Research, Inova Health System
Claude Moore Health Education and Research Building
3300 Gallows Road
Falls Church, VA 22042
E‐mail: [email protected]
Tel.: +1‐703‐776‐2540

Abstract

Background and Aims

Chronic hepatitis B virus (HBV), hepatitis C virus (HCV), nonalcoholic fatty liver disease (NAFLD), and alcohol‐associated liver disease (ALD) are main causes of chronic liver disease. We assessed the global incidence, mortality, and disability‐adjusted life‐years (DALYs) related to chronic liver disease (primary liver cancer [LC] and cirrhosis).

Approach and Results

We obtained data from the 2017 Global Burden of Disease study. In 2017, there were 2.14 million liver‐related deaths (2.06‐2.30 million), representing an 11.4% increase since 2012 (16.0% increase in LC deaths; 8.7% increase in cirrhosis deaths). LC and cirrhosis accounted for 38.3% and 61.7%, respectively, of liver deaths (LC and cirrhosis deaths were related to HBV [39% and 29%], HCV [29% and 26%], ALD [16% and 25%], and NAFLD [8% and 9%]). Between 2012 and 2017, age‐standardized incidence rate, age‐standardized death rate (ASDR), and age‐standardized DALY rate increased for LC from 11.1 to 11.8, 10.1 to 10.2, and 250.4 to 253.6 per 100,000, respectively. Although age‐standardized incidence rate for cirrhosis increased from 66.0 to 66.3, ASDR and age‐standardized DALY rate decreased from 17.1 to 16.5 and 532.9 to 510.7, respectively. The largest increase in ASDR for LC occurred in Eastern Europe (annual percent change [APC] = 2.18% [0.89%‐3.49%]), whereas the largest decrease occurred in high‐income Asia Pacific (APC = −2.88% [−3.58 to −2.18%]). ASDR for LC‐NAFLD and ALD increased annually by 1.42% (1.00%‐1.83%) and 0.53% (0.08‐0.89), respectively, whereas there were no increases for HBV (P = 0.224) and HCV (P = 0.054). ASDR for cirrhosis‐NAFLD increased (APC = 0.29% [0.01%‐0.59%]) but decreased for ALD (APC = −0.44% [−0.78% to −0.40%]), HCV (APC = −0.50% [−0.81% to −0.18%]), and HBV (APC = −1.43% [−1.71% to −0.40%]).

Conclusions

From 2012 to 2017, the global burden of LC and cirrhosis has increased. Viral hepatitis remains the most common cause of liver deaths, and NAFLD is the most rapidly growing contributor to liver mortality and morbidity.