The analysis of cirrhosis incidence and mortality in China based on the age-period-cohort model_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CUI Gui , LI Mengtong , WANG Xin , CHENG Xiaoying , ZHANG Jiaxu ,  WANG Yue

Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150000, P. R. China;

Corresponding author：

WANG Yue, Email: 406342384@qq.com

Keywords：

cirrhosis; China; age-period-queue model; incidence; mortality

DOI：

10.7507/1007-9424.202412012

Video：

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Objective To analyze the incidence and mortality of cirrhosis in China from 1992 to 2021, and to explore the impacts of age, period, and birth cohort factors on the incidence and mortality of cirrhosis. Methods By means of the Global Burden of Disease (GBD) 2021 database, the incidence and mortality of cirrhosis in China from 1992 to 2021 were analyzed. The Joinpoint software was used to analyze the temporal trends of the standardized incidence rate and standardized mortality rate of cirrhosis, and the average annual percentage change was calculated. An age-period-cohort model was constructed to deeply explore the effects of age, period, and birth cohort factors on the changing trends of the incidence and mortality of cirrhosis. Results In 2021, the incidence rate of cirrhosis in China was 772.07 per 100 000, and the mortality rate was 10.99 per 100 000, representing decreases of 5.53% and 26.98%, respectively, compared with 1992. By gender, in 2021, the incidence rate of cirrhosis in males (727.95 per 100 000) was lower than that in females (818.32 per 100 000), but the mortality rate in males (15.53 per 100 000) was higher than that in females (6.24 per 100 000). From 1992 to 2021, the ASIR of cirrhosis in China showed a decreasing trend, with an average annual decrease of 0.31%, which was statistically significant (P＜0.014). Similarly, the ASMR of cirrhosis also showed a decreasing trend, with an average annual decrease of 3.21%, which was statistically significant (P＜0.021). The age effect results showed that the incidence of cirrhosis in China generally followed a trend of first decreasing, then increasing, and then decreasing again. There was a significant downward trend in incidence in the 5–14 years old group, a significant upward trend in the 15–24 years old group, and a fluctuating downward trend after 25 years old. Mortality rates gradually increased, from 2.32 per 100 000 in the 0–4 years old group to 27.72 per 100 000 in the ≥85 years old group. The period effect results showed that the period relative risk (RR) for cirrhosis incidence first decreased and then increased, with the highest risk from 1992 to 1996 [RR=1.19, 95%CI (1.10, 1.29)]. The period RR for cirrhosis mortality showed a decreasing trend, with the highest mortality risk occurring from 1992 to 1996 [RR=1.41, 95%CI (1.36, 1.45)]. The cohort effect results indicated that the later the birth cohort, the lower the risk of cirrhosis incidence and mortality. In 2021, among the five types of cirrhosis, nonalcoholic fatty liver disease (NAFLD)-induced cirrhosis had the highest incidence rate (672.02 per 100 000), while cirrhosis caused by hepatitis B had the highest mortality rate (8.15 per 100 000). From 1992 to 2021, alcohol-related cirrhosis showed the most significant increase in incidence (37.50%), and NAFLD-induced cirrhosis showed the most significant increase in mortality (25.00%). Conclusions From 1992 to 2021, the ASIR and ASMR of cirrhosis in China show a declining trend, with males exhibiting higher incidence and mortality rates than females. Age, period, and cohort all have significant effects on the trends of cirrhosis incidence and mortality. NAFLD-induced cirrhosis has the highest incidence, while cirrhosis caused by hepatitis B has the highest mortality.

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14.	Roerecke M, Vafaei A, Hasan OSM, et al. Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis. Am J Gastroenterol, 2019, 114(10): 1574-1586.
15.	Indolfi G, Easterbrook P, Dusheiko G, et al. Hepatitis B virus infection in children and adolescents. Lancet Gastroenterol Hepatol, 2019, 4(6): 466-476.
16.	Hui Z, Yu W, Fuzhen W, et al. New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020. Lancet Reg Health West Pac, 2024, 51: 101193.
17.	Stefan N, Cusi K. A global view of the interplay between non-alcoholic fatty liver disease and diabetes. Lancet Diabetes Endocrinol, 2022, 10(4): 284-296.
18.	Lai JC, Covinsky KE, Dodge JL, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology, 2017, 66(2): 564-574.
19.	Ge PS, Runyon BA. Treatment of patients with cirrhosis. N Engl J Med, 2016, 375(8): 767-777.
20.	Bing H, Li YL. The role of bile acid metabolism in the occurrence and development of NAFLD. Front Mol Biosci, 2022, 9: 1089359.
21.	Guo X, Yin X, Liu Z, et al. Non-alcoholic fatty liver disease (NAFLD) pathogenesis and natural products for prevention and treatment. Int J Mol Sci, 2022, 23(24): 15489.
22.	Zhang X, Xi W, Liu L, et al. Improvement in quality of life and activities of daily living in patients with liver cirrhosis with the use of health education and patient health empowerment. Med Sci Monit, 2019, 25: 4602-4608.

1. Barnett R. Liver cirrhosis. Lancet, 2018, 392(10144): 275.
2. Chinese Society of Gastroenterology, Chinese Medical Association. Chinese consensus on the management of liver cirrhosis. J Dig Dis, 2024, 25(6): 332-352.
3. Carvão J, Carvão JN, Pereira V, et al. Challenges in measuring renal function in liver cirrhosis: are there implications in clinical practice? Acta Gastroenterol Belg, 2020, 83(4): 633-638.
4. Wang Y, Wang M, Liu C, et al. Global burden of liver cirrhosis 1990–2019 and 20 years forecast: results from the global burden of disease study 2019. Ann Med, 2024, 56(1): 2328521.
5. Mokdad AA, Lopez AD, Shahraz S, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med, 2014, 12: 145.
6. Lan Y, Wang H, Weng H, et al. The burden of liver cirrhosis and underlying etiologies: results from the Global Burden of Disease Study 2019. Hepatol Commun, 2023, 7(2): e0026.
7. Li M, Wang ZQ, Zhang L, et al. Burden of cirrhosis and other chronic liver diseases caused by specific etiologies in China, 1990-2016: findings from the Global Burden of Disease Study 2016. Biomed Environ Sci, 2020, 33(1): 1-10.
8. Murray CJL; GBD 2021 Collaborators. Findings from the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2259-2262.
9. Stevens GA, Alkema L, Black RE, et al. Guidelines for accurate and transparent health estimates reporting: the GATHER statement. Lancet, 2016, 388(10062): e19-e23.
10. Rosenberg PS, Miranda-Filho A, Whiteman DC. Comparative age-period-cohort analysis. BMC Med Res Methodol, 2023, 23(1): 238.
11. Gillis D, Edwards BPM. The utility of joinpoint regression for estimating population parameters given changes in population structure. Heliyon, 2019, 5(11): e02515.
12. Tapper EB, Parikh ND. Diagnosis and management of cirrhosis and its complications: a review. JAMA, 2023, 329(18): 1589-1602.
13. Lowe R, Hey P, Sinclair M. The sex-specific prognostic utility of sarcopenia in cirrhosis. J Cachexia Sarcopenia Muscle, 2022, 13(6): 2608-2615.
14. Roerecke M, Vafaei A, Hasan OSM, et al. Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis. Am J Gastroenterol, 2019, 114(10): 1574-1586.
15. Indolfi G, Easterbrook P, Dusheiko G, et al. Hepatitis B virus infection in children and adolescents. Lancet Gastroenterol Hepatol, 2019, 4(6): 466-476.
16. Hui Z, Yu W, Fuzhen W, et al. New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020. Lancet Reg Health West Pac, 2024, 51: 101193.
17. Stefan N, Cusi K. A global view of the interplay between non-alcoholic fatty liver disease and diabetes. Lancet Diabetes Endocrinol, 2022, 10(4): 284-296.
18. Lai JC, Covinsky KE, Dodge JL, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology, 2017, 66(2): 564-574.
19. Ge PS, Runyon BA. Treatment of patients with cirrhosis. N Engl J Med, 2016, 375(8): 767-777.
20. Bing H, Li YL. The role of bile acid metabolism in the occurrence and development of NAFLD. Front Mol Biosci, 2022, 9: 1089359.
21. Guo X, Yin X, Liu Z, et al. Non-alcoholic fatty liver disease (NAFLD) pathogenesis and natural products for prevention and treatment. Int J Mol Sci, 2022, 23(24): 15489.
22. Zhang X, Xi W, Liu L, et al. Improvement in quality of life and activities of daily living in patients with liver cirrhosis with the use of health education and patient health empowerment. Med Sci Monit, 2019, 25: 4602-4608.

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