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The Global, Regional, and National Burden of Cirrhosis by Cause in 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017 Publisher Pubmed



Sepanlou SG1, 9 ; Safiri S14, 15 ; Bisignano C23 ; Ikuta KS23, 25 ; Merat S1 ; Saberifiroozi M2 ; Poustchi H1 ; Tsoi D23 ; Colombara DV23 ; Abdoli A26 ; Adedoyin RA27 ; Afarideh M6 ; Agrawal S28, 29 ; Ahmad S30, 31 Show All Authors
Authors
  1. Sepanlou SG1, 9
  2. Safiri S14, 15
  3. Bisignano C23
  4. Ikuta KS23, 25
  5. Merat S1
  6. Saberifiroozi M2
  7. Poustchi H1
  8. Tsoi D23
  9. Colombara DV23
  10. Abdoli A26
  11. Adedoyin RA27
  12. Afarideh M6
  13. Agrawal S28, 29
  14. Ahmad S30, 31
  15. Ahmadian E21, 33
  16. Ahmadpour E17, 19
  17. Akinyemiju T34, 35
  18. Akunna CJ36, 38
  19. Alipour V39, 41
  20. Almasihashiani A46
  21. Almulhim AM47
  22. Alraddadi RM49
  23. Alvisguzman N50, 51
  24. Anber NH52, 53
  25. Angus C54, 122
  26. Anoushiravani A1
  27. Arabloo J42
  28. Araya EM55
  29. Asmelash D58
  30. Ataeinia B8, 145
  31. Ataro Z60
  32. Atout MMW61
  33. Ausloos F62
  34. Awasthi A28
  35. Badawi A63, 64
  36. Banach M65, 66
  37. Ramirez DFB67, 68
  38. Bhagavathula AS69, 70
  39. Bhala N71, 72
  40. Bhattacharyya K73, 74
  41. Biondi A75
  42. Bolla SR76
  43. Boloor A80
  44. Borzi AM75
  45. Butt ZA81, 82
  46. Alberto Camera LLA83, 84
  47. Camposnonato IR87
  48. Carvalho F89, 138
  49. Chu DT91
  50. Chung SC92, 93
  51. Cortesi PA95
  52. Costa VM90
  53. Cowie BC96, 98
  54. Daryani A102
  55. De Courten B104, 105
  56. Demoz GT106, 109
  57. Desai R110
  58. Dharmaratne SD23, 111
  59. Djalalinia S112
  60. Do HT113
  61. Dorostkar F40
  62. Drake TM114
  63. Dubey M115
  64. Duncan BB116
  65. Effiong A117
  66. Eftekhari A18, 119
  67. Elsharkawy A120
  68. Etemadi A11, 121
  69. Farahmand M10
  70. Farzadfar F9
  71. Fernandes E88
  72. Filip I122, 124
  73. Fischer F125
  74. Gebremedhin KBB108
  75. Geta B127
  76. Gilani SA128, 129
  77. Gill PS130
  78. Gutierrez RA131
  79. Haile MT132
  80. Hajmirzaian A5, 136
  81. Hamid SS138
  82. Hasankhani M22
  83. Hasanzadeh A4, 118
  84. Hashemian M139
  85. Hassen HY140, 142
  86. Hay SI23, 24
  87. Hayat K143, 144
  88. Heidari B6
  89. Henok A140
  90. Hoang CL145
  91. Hostiuc M146, 149
  92. Hostiuc S147, 150
  93. Hsieh VCR151
  94. Igumbor EU152, 153
  95. Ilesanmi OS154
  96. Irvani SSN137
  97. Balalami NJ155
  98. James SL23
  99. Jeemon P156
  100. Jha RP157
  101. Jonas JB158, 160
  102. Jozwiak JJ161
  103. Kabir A43
  104. Kasaeian A7, 45
  105. Kassaye HG55
  106. Kefale AT141
  107. Khalilov R32
  108. Khan MA163, 164
  109. Khan EA165
  110. Khater A166
  111. Kim YJ167
  112. Koyanagi A168, 170
  113. Vecchia CL171
  114. Lim LL172, 173
  115. Lopez AD99
  116. Lorkowski S174, 175
  117. Lotufo PA176
  118. Lozano R23, 24
  119. Magdy Abd El Razek M177
  120. Mai HT113
  121. Manafi N44, 178
  122. Manafi A179
  123. Mansournia MA3
  124. Mantovani LG95, 180
  125. Mazzaglia G94
  126. Mehta D130, 181
  127. Mendoza W182
  128. Menezes RG48
  129. Mengesha MM59
  130. Meretoja TJ184, 185
  131. Mestrovic T186, 187
  132. Miazgowski B188, 189
  133. Miller TR190, 191
  134. Mirrakhimov EM192, 193
  135. Mithra P77
  136. Moazen B159, 194
  137. Moghadaszadeh M16, 20
  138. Mohammadianhafshejani A195
  139. Mohammed S159, 196
  140. Mokdad AH23, 24
  141. Monterozamora PA86, 197
  142. Moradi G198, 199
  143. Naimzada MD200, 201
  144. Nayak V78
  145. Negoi I148, 202
  146. Nguyen TH145
  147. Oforiasenso R103, 203
  148. Oh IH204
  149. Olagunju TO205
  150. Padubidri JR79
  151. Pakshir K13
  152. Pana A206, 207
  153. Pathak M208
  154. Pourshams A1
  155. Rabiee N209
  156. Radfar A123, 210
  157. Rafiei A100, 101
  158. Ramezanzadeh K134
  159. Rana SMM211, 212
  160. Rawaf S213, 215
  161. Rawaf DL214, 216
  162. Roever L217
  163. Room R218, 219
  164. Roshandel G1, 220
  165. Safari S135
  166. Samy AM222
  167. Sanabria J223, 224
  168. Sartorius B24, 225
  169. Schmidt MI116
  170. Senthilkumaran S226
  171. Shaikh MA229
  172. Sharif M227, 228
  173. Sharifi A221
  174. Shigematsu M230
  175. Singh JA162, 231
  176. Soheili A233, 234
  177. Suleria HAR97
  178. Teklehaimanot BF56
  179. Tesfay BE56
  180. Vacante M75
  181. Vahedianazimi A235
  182. Valdez PR85, 236
  183. Vasankari TJ237
  184. Vu GT145
  185. Waheed Y238
  186. Weldegwergs KG239
  187. Werdecker A243, 244
  188. Westerman R242
  189. Wondafrash DZ107, 240
  190. Wondmieneh AB109, 126
  191. Yeshitila YG245
  192. Yonemoto N246
  193. Yu C12, 247
  194. Zaidi Z232
  195. Zarghi A133
  196. Zelbersagi S37, 169
  197. Zewdie KA241
  198. Zhang ZJ57
  199. Zhao XJ183
  200. Naghavi M23, 24
  201. Malekzadeh R1, 12
Show Affiliations
Authors Affiliations
  1. 1. Digestive Diseases Research Institute, Tehran, Iran
  2. 2. Digestive Diseases Research Institute, SHARIATI Hospital, Tehran, Iran
  3. 3. Department of Epidemiology and Biostatistics, Tehran, Iran
  4. 4. Department of Microbiology, Tehran, Iran
  5. 5. Department of Pharmacology, Tehran, Iran
  6. 6. Endocrinology and Metabolism Research Center, Tehran, Iran
  7. 7. Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran, Iran
  8. 8. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran, Iran
  9. 9. Non-communicable Diseases Research Center, Tehran, Iran
  10. 10. School of Public Health, Tehran, Iran
  11. 11. Tehran University of Medical Sciences, Tehran, Iran
  12. 12. Global Health Institute, Wuhan University, Wuhan, China
  13. 13. Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, Iran
  14. 14. Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
  15. 15. Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
  16. 16. Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  17. 17. Department of Parasitology, Tabriz University of Medical Sciences, Tabriz, Iran
  18. 18. Department of Pharmacology and Toxicology, Tabriz University of Medical Sciences, Tabriz, Iran
  19. 19. Infectious and Tropical Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  20. 20. Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  21. 21. Pharmacology and Toxicology, Tabriz University of Medical Sciences, Tabriz, Iran
  22. 22. School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
  23. 23. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
  24. 24. Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
  25. 25. Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
  26. 26. Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom, Iran
  27. 27. Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  28. 28. Public Health Foundation of India, Gurugram, India
  29. 29. Vital Strategies, Gurugram, India
  30. 30. Department of Clinical Pharmacy, Universiti Teknologi MARA (UiTM), MAHSA University, Kuala Langat, Malaysia
  31. 31. Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), MAHSA University, Kuala Langat, Malaysia
  32. 32. Department of Physiology, Baku State University, Baku, Azerbaijan
  33. 33. Institute of Radiation Problems of Azerbaijan, Baku State University, Baku, Azerbaijan
  34. 34. Department of Population Health Sciences, Duke University, Durham, NC, United States
  35. 35. Duke Global Health Institute, Duke University, Durham, NC, United States
  36. 36. Department of Public Health, The Intercountry Centre for Oral Health (ICOH) for Africa, Jos, Nigeria
  37. 37. School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
  38. 38. Department of Public Health, Federal Ministry of Health, Garki, Nigeria
  39. 39. Health Management and Economics Research Center, Tehran, Iran
  40. 40. Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
  41. 41. Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
  42. 42. Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
  43. 43. Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
  44. 44. Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran
  45. 45. Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
  46. 46. Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
  47. 47. College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  48. 48. Forensic Medicine Division, Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  49. 49. Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  50. 50. Grupo de Investigacion en Economia de la Salud (GIES), University of Cartagena, Cartagena, Colombia
  51. 51. Research Group in Hospital Management and Health Policies, University of the Coast, Barranquilla, Colombia
  52. 52. Faculty of Medicine, Mansoura, Egypt
  53. 53. Mansoura University, Mansoura, Egypt
  54. 54. School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
  55. 55. Department of Pharmacy, Adigrat University, Adigrat, Ethiopia
  56. 56. Department of Public Health, Adigrat University, Adigrat, Ethiopia
  57. 57. Department of Preventive Medicine, Wuhan University, Wuhan, China
  58. 58. Clinical Chemistry Department, University of Gondar, Gondar, Ethiopia
  59. 59. Department of Epidemiology and Biostatistics, Haramaya University, Harar, Ethiopia
  60. 60. Department of Medical Laboratory Science, Haramaya University, Harar, Ethiopia
  61. 61. School of Nursing, University of Nottingham, Amman, Jordan
  62. 62. Gastro-enterology Department, University of Liege, Liege, Belgium
  63. 63. Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, ON, Canada
  64. 64. Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
  65. 65. Department of Hypertension, Medical University of Lodz, Lodz, Poland
  66. 66. Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
  67. 67. Department of Medicine, El Bosque University, Bogota, Colombia
  68. 68. Transplant Service, University Hospital Foundation Santa Fe de Bogota, Bogota, Colombia
  69. 69. Internal Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
  70. 70. Social and Clinical Pharmacy, Charles University, Hradec Kralove, Czech Republic
  71. 71. Institutes of Applied Health Research and Translational Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
  72. 72. IAHR/ITM, University of Birmingham, Birmingham, United Kingdom
  73. 73. Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India
  74. 74. Department of Statistics, University of Calcutta, Kolkata, India
  75. 75. Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
  76. 76. Department of Biomedical Sciences, Nazarbayev University, Nur-Sultan city, Kazakhstan
  77. 77. Community Medicine, Manipal Academy of Higher Education, Mangalore, India
  78. 78. Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Mangalore, India
  79. 79. Department of Forensic Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
  80. 80. Internal Medicine, Manipal Academy of Higher Education, Mangalore, India
  81. 81. School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
  82. 82. Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
  83. 83. Medicina Interna, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
  84. 84. Comision Directiva, Ciudad Autonoma Buenos Aires, Argentina
  85. 85. Argentine Society of Medicine, Ciudad Autonoma Buenos Aires, Argentina
  86. 86. Center for Health Systems Research, Cuernavaca, Mexico
  87. 87. National Institute of Public Health, Cuernavaca, Mexico
  88. 88. REQUIMTE/LAQV, University of Porto, Porto, Portugal
  89. 89. UCIBIO, University of Porto, Porto, Portugal
  90. 90. UCIBIO, REQUIMTE, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Porto, Portugal
  91. 91. Faculty of Biology, Hanoi National University of Education, Hanoi, Viet Nam
  92. 92. Department of Health Informatics, University College London, London, United Kingdom
  93. 93. Health Data Research UK, London, United Kingdom
  94. 94. Department of Medicine, University of Milan Bicocca, Monza, Italy
  95. 95. School of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
  96. 96. WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
  97. 97. Department of Agriculture and Food Systems, University of Melbourne, Parkville, VIC, Australia
  98. 98. Department of Medicine, University of Melbourne, Parkville, VIC, Australia
  99. 99. School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
  100. 100. Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
  101. 101. Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  102. 102. Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  103. 103. Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC, Australia
  104. 104. Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia
  105. 105. Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, VIC, Australia
  106. 106. School of Pharmacy, Aksum University, Aksum, Ethiopia
  107. 107. Department of Pharmacology, Addis Ababa, Ethiopia
  108. 108. Nursing Department, Addis Ababa, Ethiopia
  109. 109. Addis Ababa University, Addis Ababa, Ethiopia
  110. 110. Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA, United States
  111. 111. Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  112. 112. Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
  113. 113. Institute for Global Health Innovations, Duy Tan University, Hanoi, Viet Nam
  114. 114. Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
  115. 115. World Food Programme, New Delhi, India
  116. 116. Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
  117. 117. Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia
  118. 118. Department of Microbiology, Maragheh University of Medical Sciences, Maragheh, Iran
  119. 119. Pharmacology and Toxicology Department, Maragheh University of Medical Sciences, Maragheh, Iran
  120. 120. Endemic Medicine and Hepatogastroentrology Department, Cairo University, Cairo, Egypt
  121. 121. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
  122. 122. Psychiatry Department, Kaiser Permanente, Fontana, CA, United States
  123. 123. College of Graduate Health Sciences, A.T. Still University, Mesa, AZ, United States
  124. 124. School of Health Sciences, A.T. Still University, Mesa, AZ, United States
  125. 125. Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
  126. 126. Nursing, Wollo University, Dessie, Ethiopia
  127. 127. Pharmacy, Wollo University, Dessie, Ethiopia
  128. 128. Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
  129. 129. BOG, Afro-Asian Institute, Lahore, Pakistan
  130. 130. Unit of Academic Primary Care, University of Warwick, Coventry, United Kingdom
  131. 131. Department of Epidemiology and Psychosocial Research, Ramon de la Fuente Muniz National Institute of Psychiatry, Mexico City, Mexico
  132. 132. Department of Nursing, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
  133. 133. Department of Medicinal and Pharmaceutical Chemistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  134. 134. Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  135. 135. Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  136. 136. Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  137. 137. Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  138. 138. Medicine, Aga Khan University, Karachi, Pakistan
  139. 139. Department of Biology, Utica College, Utica, NY, United States
  140. 140. Department of Public Health, Mizan-Tepi University, Tepi, Ethiopia
  141. 141. Pharmacy Department, Mizan-Tepi University, Tepi, Ethiopia
  142. 142. Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
  143. 143. Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
  144. 144. Department of Pharmacy Administration and Clinical Pharmacy, Xian Jiaotong University, Xian, China
  145. 145. Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
  146. 146. Department of General Surgery), Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  147. 147. Faculty of Dentistry, Department of Legal Medicine and Bioethics), Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  148. 148. General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  149. 149. Department of Internal Medicine, Bucharest Emergency Hospital, Bucharest, Romania
  150. 150. Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
  151. 151. Department of Health Services Administration, China Medical University, Taichung, Taiwan
  152. 152. School of Public Health, University of the Western Cape, Cape Town, South Africa
  153. 153. Department of Public Health, Walter Sisulu University, Mthatha, South Africa
  154. 154. Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
  155. 155. Department of Psychosis, Babol Noshirvani University of Technology, Babol, Iran
  156. 156. Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
  157. 157. Department of Community Medicine, Banaras Hindu University, Varanasi, India
  158. 158. Department of Ophthalmology, Heidelberg University, Mannheim, Germany
  159. 159. Heidelberg Institute of Global Health (HIGH), Heidelberg University, Mannheim, Germany
  160. 160. Beijing Institute of Ophthalmology, Beijing Ophthalmology & Visual Science Key Laboratory, Beijing Tongren Hospital, Beijing, China
  161. 161. Department of Family Medicine and Public Health, University of Opole, Opole, Poland
  162. 162. Department of Medicine, Birmingham, AL, United States
  163. 163. University of Alabama at Birmingham, Birmingham, AL, United States
  164. 164. University of Tennessee, Knoxville, TN, United States
  165. 165. Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
  166. 166. Internal Medicine and Gastroenterology Department, National Hepatology and Tropical Research Institute, Cairo, Egypt
  167. 167. School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
  168. 168. CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
  169. 169. Gastroenterology Department, Tel Aviv Saurasky Medical Center, Tel Aviv, Israel
  170. 170. Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
  171. 171. Clinical Medicine and Community Health, University of Milan, Milano, Italy
  172. 172. Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  173. 173. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
  174. 174. Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany
  175. 175. Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Jena, Germany
  176. 176. Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil
  177. 177. Ophthalmology Department, Aswan Faculty of Medicine, Aswan, Egypt
  178. 178. Ophthalmology Department, University of Manitoba, Winnipeg, MB, Canada
  179. 179. Department of Surgery, University of Virginia, Charlottesville, VA, United States
  180. 180. Value-Based Healthcare Unit, IRCCS MultiMedica, Sesto San Giovanni, Italy
  181. 181. Division of Gastroenterology and Hepatobiliary disease, New York Medical College, Valhalla, NY, United States
  182. 182. Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
  183. 183. Wuhan Polytechnic University, Wuhan, China
  184. 184. Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
  185. 185. University of Helsinki, Helsinki, Finland
  186. 186. Clinical Microbiology and Parasitology Unit, Zora Profozic Polyclinic, Zagreb, Croatia
  187. 187. University Centre Varazdin, University North, Varazdin, Croatia
  188. 188. Center for Innovation in Medical Education, Szczecin, Poland
  189. 189. Pomeranian Medical University, Szczecin, Poland
  190. 190. Pacific Institute for Research & Evaluation, Calverton, MD, United States
  191. 191. School of Public Health, Curtin University, Perth, WA, Australia
  192. 192. Faculty of Internal Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
  193. 193. Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
  194. 194. Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
  195. 195. Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
  196. 196. Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
  197. 197. Department of Public Health Sciences, University of Miami, Miami, FL, United States
  198. 198. Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
  199. 199. Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
  200. 200. Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
  201. 201. Experimental Surgery and Oncology Laboratory, Kursk State Medical University of the Ministry of Health of the Russian Federation, Kursk, Russian Federation
  202. 202. General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
  203. 203. Accra, Ghana
  204. 204. Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
  205. 205. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
  206. 206. Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
  207. 207. Center for Health Outcomes & Evaluation, Bucharest, Romania
  208. 208. Research & Publication Cell, Kalinga Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, India
  209. 209. Department of Chemistry, Sharif University of Technology, Tehran, Iran
  210. 210. College of Medicine, University of Central Florida, Orlando, FL, United States
  211. 211. University Institute of Public Health, University of Lahore, Lahore, Pakistan
  212. 212. Public Health Department, University of Health Sciences, Lahore, Pakistan
  213. 213. Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
  214. 214. WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, United Kingdom
  215. 215. Academic Public Health Department, Public Health England, London, United Kingdom
  216. 216. University College London Hospitals, London, United Kingdom
  217. 217. Department of Clinical Research, Federal University of Uberlandia, Uberlandia, Brazil
  218. 218. Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
  219. 219. Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
  220. 220. Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
  221. 221. Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
  222. 222. Department of Entomology, Ain Shams University, Cairo, Egypt
  223. 223. Department of Surgery, Marshall University, Huntington, WV, United States
  224. 224. Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, OH, United States
  225. 225. Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
  226. 226. Emergency Department, Manian Medical Centre, Erode, India
  227. 227. Department of Basic Sciences, Islamic Azad University, Sari, Iran
  228. 228. Department of Laboratory Sciences, Islamic Azad University, Sari, Iran
  229. 229. Sindh, Pakistan
  230. 230. National Institute of Infectious Diseases, Tokyo, Japan
  231. 231. Medicine Service, US Department of Veterans Affairs+++(VA), Birmingham, AL, United States
  232. 232. Department of Epidemiology, University Hospital of Setif, Setif, Algeria
  233. 233. Medical Surgical Nursing Department, Urmia University of Medical Science, Urmia, Iran
  234. 234. Emergency Nursing Department, Semnan University of Medical Sciences, Iran
  235. 235. Trauma Research Center, Nursing Facility, Baqiyatallah University of Medical Sciences, Tehran, Iran
  236. 236. Velez Sarsfield Hospital, Buenos Aires, Argentina
  237. 237. UKK Institute, Tampere, Finland
  238. 238. Foundation University Medical College, Foundation University, Islamabad, Pakistan
  239. 239. Clinical Pharmacy Unit, Mekelle University, Mekelle, Ethiopia
  240. 240. Department of Pharmacology and Toxicology, College of Health Sciences, School of Pharmacy, Mekelle University, Mekelle, Ethiopia
  241. 241. Pharmacy, Mekelle University, Mekelle, Ethiopia
  242. 242. Competence Center of Mortality-Follow-Up, German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany
  243. 243. Demographic Change and Ageing Research Area, Federal Institute for Population Research, Wiesbaden, Germany
  244. 244. Center of Population and Health, Wiesbaden, Germany
  245. 245. Nursing, Arba Minch University, Arba Minch, Ethiopia
  246. 246. Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
  247. 247. Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China

Source: The Lancet Gastroenterology and Hepatology Published:2020


Abstract

Background: Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods: We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings: In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27–1·45) deaths (440 000 [416 000–518 000; 33·3%] in females and 883 000 [838 000–967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000–948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3–2·6) of total deaths globally in 2017 compared with 1·9% (1·8–2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2–22·3) per 100 000 population in 1990 to 16·5 (15·8–18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8–38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8–10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3–4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4–133·4] per 100 000 in 2017). There were 10·6 million (10·3–10·9) prevalent cases of decompensated cirrhosis and 112 million (107–119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation: Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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