Liver cirrhosis mortality found to be greater than that of five major cancers

A new study presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – found that liver cirrhosis mortality is greater than that of five major cancers, implying the development of appropriate interventions to treat or prevent liver cirrhosis must be prioritized.

The study, sponsored by the Korean Association for the Study of the Liver and the Korean Liver Foundation, was conducted in response to the low survival rate of liver cirrhosis patients and the need to design improved health policy regarding this condition. The researchers, from the Republic of Korea, estimated the mortality of liver cirrhosis and compared it to that of five major cancers: lung, colorectal, stomach, liver and breast.

"Accurate data regarding the burden of diseases are necessary to inform health care policy, prioritize appropriate research and interventions, and allocate resources," says Dong Joon Kim, MD, PhD; chair, Division of Gastroenterology and Hepatology at Hallym University College of Medicine, and a corresponding investigator in the study.

According to Dr. Kim, mortality rates differ between high‐ and low‐income countries for liver cirrhosis and cancers of the lung, liver, stomach, colorectal and breast, but are substantial worldwide. "Liver cirrhosis causes 1.2 million deaths yearly worldwide, ranking as the 14th and 10th leading cause of death in the world and in most developed countries, respectively. To compare the burden of one disease with that of another, it's necessary to consider the age at death, the life expectancy of people affected by each disease, and the degree of disability that each condition imposes on those who live with the disease. Different metrics – such as deaths, years of life lost, and years lived with disability – highlight different aspects of a population's health status, and survival may be the most important of those," says Dr. Kim.

The researchers studied nationally representative mortality across all of these diseases using data from both the Cause of Death Statistics and National Health Insurance Service‐National Sample Cohort (NHIS‐ NSC) databases. NHIS‐NSC provides a cohort data of 1,025,340 patient‐representative sample for the 46,605,433 population of Korea from 2002 to 2010. Liver cirrhosis was carefully defined using ICD‐10

codes, and eight‐year mortality from 2002 to 2010 was compared with that of the cancers (also defined using ICD‐10 codes).

According to the NHIS‐NSC data, 800 out of 2,609 liver cirrhosis patients in 2002 died during the following eight years, while 1,316 out of 4,852 of the patients with the five major cancers also died during this period. The relative mortality of liver cirrhosis in comparison to the five cancers studied was greater after adjusting for age, gender, area of residence, type of insurance, insurance premium level (a proxy for income level) and co‐existing diseases and conditions.

The researchers then used sensitive analysis to check the robustness of the results, excluding patients with both liver cirrhosis and any of the five cancers. Relative mortality for liver cirrhosis was still greater even when mortality‐related factors were adjusted for, says Dr. Kim. In another analysis of the data, the researchers limited the patients with liver cirrhosis to those with decompensated liver cirrhosis, and found that relative mortality for this condition was even greater when compared to the five cancers.

"More importantly, 70.9 percent of liver cirrhosis patients died before the age of 65, while 54.6 percent of the patients with the five cancers studied died after the age of 65 years. Therefore, the socioeconomic burden of liver cirrhosis outweighs that of cancers. This finding might help to adequately allocate health resources and the proper implementation of health policies," says Dr. Kim.

While liver cirrhosis survival rates were known to be low, few studies have compared them to other major diseases, says Dr. Kim, noting "the socioeconomic impacts could be greater when considering that more males and younger patients are subject to death from liver cirrhosis than from cancers. This implies that we need to prioritize the development of appropriate health interventions for liver cirrhosis just as we have done for cancer."