Incidence and prevalence of cirrhosis in the United Kingdom, 1992–2001: A general population-based study

doi:10.1016/j.jhep.2008.05.023

Journal of Hepatology

Volume 49, Issue 5, November 2008, Pages 732-738

https://doi.org/10.1016/j.jhep.2008.05.023 Get rights and content

Background/Aims

To determine the incidence and prevalence of cirrhosis in the United Kingdom.

Methods

We identified patients aged 25 or over with cirrhosis, oesophageal varices or portal hypertension from the UK General Practice Research Database between 1992 and 2001. We measured incidence rates by sex, year and aetiology, incidence rate ratios and estimated prevalence figures.

Results

Three thousand three hundred and sixty cases of cirrhosis were identified. Crude incidence was 14.55 per 100,000 person years increasing from 12.05 to 16.99 per 100,000 person years from 1992 to 2001. Incidence was over 50% higher in men compared with women (adjusted incidence rate ratio 1.52 (95%CI [1.42–1.63])). A statistically significant increase in incidence of both alcoholic cirrhosis and non-alcohol-related cirrhosis was seen in men and women. Prevalence of cirrhosis was an estimated 76.3 per 100,000 population aged over 25 in mid-2001.

Conclusions

There was a 45% increase in the incidence of cirrhosis during the decade 1992–2001 in the UK and a 68% increase in prevalence. Cirrhosis occurred more commonly and at younger ages in men than women. Cirrhosis represents a growing burden of morbidity and mortality in the UK, with an estimated 30,000 people living with cirrhosis and at least 7000 new cases being diagnosed each year.

Section snippets

Background

Cirrhosis is a major cause of death, accounting for an estimated 800,000 deaths each year worldwide [1]. In 2005, 1% of all deaths of people aged 25 years or over in England and Wales were attributed to chronic liver disease and cirrhosis according to death certification information [2]. In contrast to much of Western Europe, America and Australasia, where mortality from cirrhosis has remained constant or in decline, mortality from cirrhosis in the UK has tripled over the last few decades [3],

Methods

The General Practice Research Database (GPRD) is a longitudinal database consisting of anonymous computerised primary care records for over 13 million patients in the UK, including over 40 million person years of data. Data contained within this database, including diagnoses, clinical test results, observations, prescriptions and major medical events, are recorded through direct entry during face-to-face general practice appointments and also following information received from secondary care,

Study population

A total of 3360 incident cases of cirrhosis aged 25 or over were identified between 1992 and 2001, 58% of whom were male. The median age at diagnosis was 56.3 years in men and 61.3 years in women (p < 0.001). Thirteen per cent of cases had their first recording of cirrhosis concurrent with the recording of time of death following correspondence from secondary care services. Nearly two fifths of patients (n = 1287, 38.3%) had a recording of problem drinking within their GP records (Table 1). For

Discussion

We found a 45% increase in the incidence of cirrhosis in the UK in the decade between 1992 and 2001 and a 68% rise in the prevalence. Cirrhosis occurred more commonly and at younger ages in men than women. Nonetheless, a significant increase in incidence was seen for all age groups and for both sexes across the period under study. Incidence of both alcoholic and non-alcohol-related cirrhosis increased in males and in females during the period. Applying our 2001 prevalence and incidence figures

Acknowledgement

J.W. had the original idea for the study. K.M.F. and M.S.D. were responsible for data management. G.P.A. performed the case validation. K.M.F. performed the data analysis and drafted the original paper. J.W., T.C., G.P.A., and M.S.D. revised the paper critically and all authors approved the final version. K.M.F. acts as guarantor for this paper.

Funding: J.W. is funded by a Department of Health Clinician Scientist Fellowship. Funding for K.M.F. is within grant awarded to J.W. The Department of

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^☆: The authors declare that they do not have anything to disclose regarding funding from industries or conflict of interest with respect to this manuscript.

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Incidence and prevalence of cirrhosis in the United Kingdom, 1992–2001: A general population-based study☆

Background/Aims

Methods

Results

Conclusions

Section snippets

Background

Methods

Study population

Discussion

Acknowledgement

J Hepatol

Lancet

Am J Gastroenterol

A 20-year prospective study of cirrhosis

Br Med J (Clin Res Ed)

A 20-year prospective study of cirrhosis

Br Med J (Clin Res Ed)

The General Practice Research Database: quality of morbidity data

Popul Trends