Changing epidemiology of cirrhosis from 2010 to 2019: results from the Global Burden Disease study 2019

Liver cirrhosis is a significant yet largely preventable and underappreciated cause of global health loss. This study aimed to profile the global and regional burdens of liver cirrhosis between 2010 and 2019 and the contributions of various aetiologies. Data on the incidence, mortality, and disability-adjusted life years (DALYs) of cirrhosis were obtained from the Global Burden of Disease 2019 study. The burden of cirrhosis was estimated by age, sex, region, aetiology, and socio-demographic index (SDI). The temporal trend was quantified using the annual percentage changes (APC.) Globally, there were 2.05 million new cases and 1.47 million deaths due to cirrhosis in 2019. From 2010 to 2019, the age-standardized incidence rate (ASIR) for cirrhosis increased slightly from 25.19 to 25.35 worldwide, while the age-standardized death rate (ASDR) and age-standardized DALYs (ASDALYs) decreased from 20.37 to 18.00 and 639.86 to 560.43, respectively. Cirrhosis incidence, mortality and DALYs were consistently higher in males than females. Stratification according to the socio-demographic index (SDI) revealed that low SDI countries had the highest ASDR and ASDALYs in 2019, while middle SDI countries had the highest ASIR. Regarding the aetiology of cirrhosis, hepatitis C accounted for the largest proportion of cirrhosis-related incidence (26.9%), death (26.8%) and DALYs (26.3%); however, non-alcoholic fatty liver disease (NAFLD) exhibited a rapidly growing cause of incident cirrhosis (+26.7%), cirrhosis-related death (+25.1%), and DALYs (+21.0%) worldwide during this period. The ASIR for NAFLD also significantly increased with APC 1.080 over the study period. Albeit the global burden of cirrhosis incidence increased from 2010 to 2019, cirrhosis-associated deaths and DALYs declined significantly. Notably, NAFLD exhibited the most significant increase as a contributor to cirrhosis worldwide. Global burden of cirrhosis incidence increased from 2010 to 2019.Cirrhosis-associated death and DALYs declined significantly during this period.Non-alcoholic fatty liver disease (NAFLD) exhibited the most significant increase as a contributor to cirrhosis worldwide. Global burden of cirrhosis incidence increased from 2010 to 2019. Cirrhosis-associated death and DALYs declined significantly during this period. Non-alcoholic fatty liver disease (NAFLD) exhibited the most significant increase as a contributor to cirrhosis worldwide.

肝硬化是一类危害严重、且在很大程度上可预防却未得到充分重视的全球健康损失诱因。本研究旨在剖析2010至2019年间全球及各地区的肝硬化疾病负担，以及各类病因的贡献占比。本研究从《2019年全球疾病负担研究》（Global Burden of Disease 2019 study）获取了肝硬化的发病率、死亡率与伤残调整寿命年（Disability-Adjusted Life Years, DALYs）相关数据，并按年龄、性别、地区、病因及社会人口学指数（Socio-demographic Index, SDI）对肝硬化疾病负担进行分层估算。研究通过年度变化百分比（Annual Percentage Change, APC）量化疾病负担的时间趋势。2019年全球肝硬化新增病例达205万例，死亡病例147万例。2010至2019年间，全球肝硬化年龄标化发病率（Age-Standardized Incidence Rate, ASIR）从25.19小幅升至25.35；而年龄标化死亡率（Age-Standardized Death Rate, ASDR）与年龄标化伤残调整寿命年率（Age-Standardized DALYs, ASDALYs）则分别从20.37降至18.00、从639.86降至560.43。肝硬化的发病率、死亡率及伤残调整寿命年在男性群体中始终高于女性。按社会人口学指数分层分析显示，2019年低社会人口学指数国家的年龄标化死亡率与年龄标化伤残调整寿命年率最高，而中社会人口学指数国家的年龄标化发病率最高。在肝硬化病因方面，丙型肝炎是肝硬化相关发病（26.9%）、死亡（26.8%）及伤残调整寿命年损失（26.3%）占比最高的病因；但在此期间，非酒精性脂肪性肝病（Non-Alcoholic Fatty Liver Disease, NAFLD）已成为全球范围内增长最快的肝硬化诱因，其相关新增病例、死亡病例及伤残调整寿命年损失分别增长了26.7%、25.1%与21.0%。本研究周期内，非酒精性脂肪性肝病相关的年龄标化发病率也以1.080的年度变化百分比实现显著增长。尽管2010至2019年全球肝硬化发病负担有所上升，但肝硬化相关死亡病例及伤残调整寿命年损失均出现显著下降。值得注意的是，非酒精性脂肪性肝病已成为全球范围内贡献占比增长最显著的肝硬化诱因。