Trends in the incidence of cirrhosis in global from 1990 to 2019: A joinpoint and age-period-cohort analysis

Cirrhosis remains a major public health concern globally; the burden of cirrhosis should be further clarified worldwide and helped us to understand the current situation of cirrhosis. In the present study, we estimate DALYs and mortality rates attributable to several major cirrhosis risk factors and use joinpoint and age-period-cohort methods to determine the trends of cirrhosis incidence and deaths in the global population in the 1990-2019 period. Globally, from 1990 to 2019, the incidence of cirrhosis, deaths due to cirrhosis, and cirrhosis DALY cases increased from 1274 (10(3), 95% uncertainty interval [UI]: 1027.2-1548.5) to 2051.6 (10(3), 95% UI: 1661.4-2478.1), 1013 (10(3), 95% UI: 948.9-1073.9) to 1472 (10(3), 95% UI: 1374.6-1578.7), and 34727.7 (10(3), 95% UI: 32383.0-37132.8) to 46189.4 (10(3), 95% UI: 43027.1-49551.3), respectively. Hepatitis virus was the most important cirrhosis mortality risk factor. Globally, hepatitis virus infection (HBV+HCV) accounted for more than 45% of the incidence of cirrhosis cases and about 50% of cirrhosis deaths. Importantly, from 1990 to 2019, the proportion of cirrhosis incidence due to HBV decreased from 24.3% to 19.8%, whereas that due to alcohol use increased from 18.7% to 21.3%. Additionally, the proportion of NAFLD-induced cirrhosis incidence increased from 5.5% to 6.6% over the same period. Our findings on the global disease burden of cirrhosis provide a valuable resource for developing targeted prevention strategies.

Automated summary

Cirrhosis is a major public health concern globally, with increasing incidence, deaths, and DALY cases from 1990 to 2019. Hepatitis virus infection is the most important risk factor for cirrhosis mortality, accounting for over 45% of cases and deaths. The proportion of cirrhosis incidence due to HBV has decreased, while that due to alcohol use and NAFLD has increased.