Liver cirrhosis in Malaysia: Peculiar epidemiology in a multiracial Asian country

Background and Aim: To determine the etiology of liver cirrhosis and risk factors for hepatocellular carcinoma (HCC) in a multiracial Asian population. Methods: Consecutive patients with liver cirrhosis presenting to outpatient clinics and inpatient service at the University of Malaya Medical Centre from 1 April 2006 to 31 May 2009 were included. Results: A total of 460 patients were included in the study: 317 male patients (68.9%) and 143 female patients (31.1%), with a mean age of 58.8 years (range: 15-87 years). The major causes of cirrhosis were: chronic hepatitis B, n = 212, 46.1%; chronic hepatitis C, n = 85, 18.5%; cryptogenic, n = 71, 15.4%; alcohol, n = 58, 12.6% and autoimmune, n = 9, 2.0%. Alcohol was the main etiology in Indians (51.1%) compared to Malay (0%) and Chinese (4.4%) (both P < 0.001). Hepatitis B was the predominant etiology in Malay (47.9%) and Chinese (58.8%) compared to Indians (5.6%) (both P < 0.001). Hepatitis C cirrhosis was highest in Malays (25.0%). 136 patients (29.6%) had concurrent HCC. Male sex (P < 0.001), age > 60 years (P = 0.014), hepatitis B (P < 0.001), hepatitis C (P = 0.006) and cryptogenic cause (P = 0.002) were found to be independent risk factors for HCC. Conclusions: The etiology of cirrhosis has a peculiar pattern based on racial differences in alcohol intake and in the prevalence of hepatitis B.