Burden of liver diseases in the world

doi:10.1016/j.jhep.2018.09.014

Journal of Hepatology

Volume 70, Issue 1, January 2019, Pages 151-171

https://doi.org/10.1016/j.jhep.2018.09.014 Get rights and content

Summary

Liver disease accounts for approximately 2 million deaths per year worldwide, 1 million due to complications of cirrhosis and 1 million due to viral hepatitis and hepatocellular carcinoma. Cirrhosis is currently the 11th most common cause of death globally and liver cancer is the 16th leading cause of death; combined, they account for 3.5% of all deaths worldwide. Cirrhosis is within the top 20 causes of disability-adjusted life years and years of life lost, accounting for 1.6% and 2.1% of the worldwide burden. About 2 billion people consume alcohol worldwide and upwards of 75 million are diagnosed with alcohol-use disorders and are at risk of alcohol-associated liver disease. Approximately 2 billion adults are obese or overweight and over 400 million have diabetes; both of which are risk factors for non-alcoholic fatty liver disease and hepatocellular carcinoma. The global prevalence of viral hepatitis remains high, while drug-induced liver injury continues to increase as a major cause of acute hepatitis. Liver transplantation is the second most common solid organ transplantation, yet less than 10% of global transplantation needs are met at current rates. Though these numbers are sobering, they highlight an important opportunity to improve public health given that most causes of liver diseases are preventable.

Section snippets

Introduction and global burden

Liver disease accounts for approximately 2 million deaths per year worldwide, 1 million due to complications of cirrhosis and 1 million due to viral hepatitis and hepatocellular carcinoma (HCC).¹ Accurate statistics are not always available because cause-specific mortality data are sparse for many regions where liver disease is highly prevalent, particularly in Africa. Moreover, approximately one-third of all countries worldwide do not have accurate mortality data. Even in developed countries

Global mortality

Globally, cirrhosis currently causes 1.16 million deaths, and liver cancer 788,000 deaths, making them the 11th and 16th most common causes of death, respectively, each year (Table 1). Combined, they account for 3.5% of all deaths worldwide. This marks an increase from 2000, when liver-related mortality accounted for 3% of all deaths, with cirrhosis and liver cancer ranking as the 13th and 20th leading causes of death, respectively. The burden is likely higher if one accounts for deaths due to

Global morbidity

Besides an increased risk of mortality, the economic impact is high and quality of life indices are low in patients with chronic liver disease.⁹ Global and regional-level estimates of chronic liver disease-related disability-adjusted life years (DALYs) and years of life lost consistently show cirrhosis within the top 20 causes (Table 2). The largest burden is seen in South-East Asia.[10], [11] Liver diseases can cause a variety of extrahepatic morbidities, which significantly contribute to

Alcohol-associated liver disease

Alcohol-associated liver disease (AALD), is a major cause of liver disease worldwide.¹³ Further, alcohol use often exacerbates liver injury, as it coexists with other factors (e.g. viral hepatitis). According to the World Health Organization (WHO), about 2 billion people consume alcohol worldwide and upwards of 75 million are diagnosed with AUDs.¹⁴ Worldwide annual consumption in 2010 was 6.2 litres of alcohol per person aged 15 years or older. In Belarus, Moldova and Lithuania, annual per

Acute liver failure

The estimated incidence of ALF varies between 1.4 per million population in Spain¹⁴⁸ to 5.5 per million population in the US.¹⁴⁹ The causes vary geographically. Drugs are the most common cause in the West, while in large parts of the East viruses continue to remain the most important cause of ALF, followed by drugs.¹⁵⁰ While hepatitis E is the most common cause of ALF in India and Africa, hepatitis B remains the most common cause in China and Korea.¹⁵⁰ The type of drugs causing ALF vary between

Liver transplantation

Liver transplantation is the second most common solid organ transplantation after kidney transplantation worldwide.²²⁷ However, less than 10% of global organ transplantation needs are met at current rates of transplantation.²²⁷ In 2015, 126,670 solid organs were transplanted worldwide: 66.5% were kidney transplants and 22% were liver transplants.²²⁷ Living donor transplantation constituted 42% of kidney transplants and 21% of liver transplants.²²⁷ Although a steady increase in transplants was

Outlook and projections

Liver disease accounts for a significant burden of disease and costs worldwide. Currently the major cause of acute liver disease is viral hepatitis, while alcohol and viral hepatitis are the main causes of chronic liver disease. These trends are changing and in the future DILI will be increasingly recognised as a cause of acute hepatitis. Vaccination and newer drugs will reduce the burden of viral related liver disease in developed countries; where access to health-related resources is limited,

Financial support

National Institute on Alcohol Abuse and Alcoholism. Grant Number: UL1 TR000135 (PSK). Baylor Foundation Grant (SKA)

Conflict of interest

The authors declare no conflicts of interest that pertain to this work.

Please refer to the accompanying ICMJE disclosure forms for further details.

Authors’ contributions

Authors had access to all the study data, take responsibility for the accuracy of the analysis, and had authority over manuscript preparation and the decision to submit the manuscript for publication. All authors approve the manuscript.

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^†: Co-first authors.

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SeminarBurden of liver diseases in the world

Summary

Section snippets

Introduction and global burden

Global mortality

Global morbidity

Alcohol-associated liver disease

Acute liver failure

Liver transplantation

Outlook and projections

Financial support

Conflict of interest

Authors’ contributions

Lancet

Lancet

Lancet

J Hepatol

J Hepatol

Hepatology

Hepatology

Clin Liver Dis

Lancet

Lancet

Vaccine

J Hepatol

Lancet

J Hepatol

Pathol Biol

Lancet Infect Dis

J Hepatol

J Hepatol

Lancet

Lancet

J Hepatol

J Hepatol

Gastroenterology

J Hepatol

J Hepatol

Ann Oncol

Best Prac Res Clin Gastroenterol

J Hepatol

World J Surg Oncol

Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis

BMC Med

Liver cirrhosis with and without mention of alcohol as cause of death

Br J Addict

Underestimation of liver-related mortality in the United States

Gastroenterology

Trends in burden of cirrhosis and hepatocellular carcinoma by underlying liver disease in US veterans, 2001-2013

Gastroenterology

Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis

BMC Med

Hepatitis B and C virus infections in hepatocellular carcinoma and cirrhosis in Mongolia

Eur J Cancer Prev

Direct and indirect economic burden of chronic liver disease in the United States

Clin Gastroenterol Hepatol

Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015

Global health estimates 2015: disease burden by cause, age, sex, by country and by region, 2000-2015

Burden of gastrointestinal, liver, and pancreatic diseases in the United States

Gastroenterology

Global status report on alcohol 2004

Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008

Clin Gastroenterol Hepatol

Cirrhosis and mortality risks of biopsy-verified alcoholic pure steatosis and steatohepatitis: a nationwide registry-based study

Aliment Pharmacol Ther

Fibrosis progression occurs in a subgroup of heavy drinkers with typical histological features

Aliment Pharmacol Ther

Long-term follow-up and liver-related death rate in patients with non-alcoholic and alcoholic related fatty liver disease

BMC Gastroenterol

EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

Jurnal Hepatol

Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010

JAMA

The globalization of nonalcoholic fatty liver disease: prevalence and impact on world health

Hepatology

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults

Lancet

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants

Lancet

Seminar
Burden of liver diseases in the world