Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017
Introduction and objectives: Cirrhosis-related mortality is underestimated and is increasing; extrahepatic factors may contribute. We examined trends in cirrhosis mortality from 1999-2017 in the United States attributed to liver-related (varices, peritonitis, hepatorenal syndrome, hepatic encephalop...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268121002647 |
| _version_ | 1818403913636773888 |
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| author | Nagasri Shankar Azaan Ramani Connor Griffin Uchenna Agbim Donghee Kim Aijaz Ahmed Sumeet K. Asrani |
| author_facet | Nagasri Shankar Azaan Ramani Connor Griffin Uchenna Agbim Donghee Kim Aijaz Ahmed Sumeet K. Asrani |
| author_sort | Nagasri Shankar |
| collection | DOAJ |
| description | Introduction and objectives: Cirrhosis-related mortality is underestimated and is increasing; extrahepatic factors may contribute. We examined trends in cirrhosis mortality from 1999-2017 in the United States attributed to liver-related (varices, peritonitis, hepatorenal syndrome, hepatic encephalopathy, hepatocellular carcinoma, sepsis) or extrahepatic (cardiovascular disease, influenza and pneumonia, diabetes, malignancy) causes, and compared mortality trends with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) populations. Materials and methods: A national mortality database was used. Changes in age-standardized mortality over time were determined by joinpoint analysis. Average annual percentage change (AAPC) was estimated. Results: Cirrhosis cohort: From 1999-2017, both liver-related (AAPC 1.3%; 95% confidence interval [CI] 0.7-1.9) and extrahepatic mortality (AAPC 1.0%; 95% CI 0.7-1.2) increased. Cirrhosis vs other chronic disease cohorts: changes in all-cause mortality were higher in cirrhosis (AAPC 1.0%; 95% CI 0.7-1.4) than CHF (AAPC 0.1%; 95% CI -0.5- 0.8) or COPD (AAPC -0.4%; 95% CI -0.6- -0.2). Sepsis mortality was highest in cirrhosis (AAPC 3.6%, 95% 3.2- 4.1) compared to CHF (AAPC 0.6%, 95% CI -0.5- 1.7) or COPD (AAPC 0.8%, 95% CI 0.5- 1.2). Cardiovascular mortality increased in cirrhosis (AAPC 1.3%, 95% CI 1.1- 1.5), declined in CHF (AAPC -2.0%, 95% CI -5.3- 1.3) and remained unchanged in COPD (AAPC 0.1%, 95% CI -0.2- 0.4). Extrahepatic mortality was higher among women, rural populations, and individuals >65 years with cirrhosis. Conclusions: Extrahepatic causes of death are important drivers of mortality and differentially impact cirrhosis compared to other chronic diseases. |
| first_indexed | 2024-12-14T08:31:49Z |
| format | Article |
| id | doaj.art-a2fe1f7eabde42f6864bd75125a25c37 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-12-14T08:31:49Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-a2fe1f7eabde42f6864bd75125a25c372022-12-21T23:09:31ZengElsevierAnnals of Hepatology1665-26812021-12-0126100565Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017Nagasri Shankar0Azaan Ramani1Connor Griffin2Uchenna Agbim3Donghee Kim4Aijaz Ahmed5Sumeet K. Asrani6Baylor University Medical Center, Dallas, TX, USABaylor University Medical Center, Dallas, TX, USABaylor University Medical Center, Dallas, TX, USAThe University of Tennessee Health Science Center, Saint Louis University, MO, USAStanford University School of Medicine, Stanford, CA, USAStanford University School of Medicine, Stanford, CA, USABaylor University Medical Center, Dallas, TX, USA; Corresponding author.Introduction and objectives: Cirrhosis-related mortality is underestimated and is increasing; extrahepatic factors may contribute. We examined trends in cirrhosis mortality from 1999-2017 in the United States attributed to liver-related (varices, peritonitis, hepatorenal syndrome, hepatic encephalopathy, hepatocellular carcinoma, sepsis) or extrahepatic (cardiovascular disease, influenza and pneumonia, diabetes, malignancy) causes, and compared mortality trends with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) populations. Materials and methods: A national mortality database was used. Changes in age-standardized mortality over time were determined by joinpoint analysis. Average annual percentage change (AAPC) was estimated. Results: Cirrhosis cohort: From 1999-2017, both liver-related (AAPC 1.3%; 95% confidence interval [CI] 0.7-1.9) and extrahepatic mortality (AAPC 1.0%; 95% CI 0.7-1.2) increased. Cirrhosis vs other chronic disease cohorts: changes in all-cause mortality were higher in cirrhosis (AAPC 1.0%; 95% CI 0.7-1.4) than CHF (AAPC 0.1%; 95% CI -0.5- 0.8) or COPD (AAPC -0.4%; 95% CI -0.6- -0.2). Sepsis mortality was highest in cirrhosis (AAPC 3.6%, 95% 3.2- 4.1) compared to CHF (AAPC 0.6%, 95% CI -0.5- 1.7) or COPD (AAPC 0.8%, 95% CI 0.5- 1.2). Cardiovascular mortality increased in cirrhosis (AAPC 1.3%, 95% CI 1.1- 1.5), declined in CHF (AAPC -2.0%, 95% CI -5.3- 1.3) and remained unchanged in COPD (AAPC 0.1%, 95% CI -0.2- 0.4). Extrahepatic mortality was higher among women, rural populations, and individuals >65 years with cirrhosis. Conclusions: Extrahepatic causes of death are important drivers of mortality and differentially impact cirrhosis compared to other chronic diseases.http://www.sciencedirect.com/science/article/pii/S1665268121002647Chronic liver diseaseNational center for health statisticsCHFCOPDMortalityAPC |
| spellingShingle | Nagasri Shankar Azaan Ramani Connor Griffin Uchenna Agbim Donghee Kim Aijaz Ahmed Sumeet K. Asrani Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017 Annals of Hepatology Chronic liver disease National center for health statistics CHF COPD Mortality APC |
| title | Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017 |
| title_full | Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017 |
| title_fullStr | Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017 |
| title_full_unstemmed | Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017 |
| title_short | Extrahepatic causes of death in cirrhosis compared to other chronic conditions in the United States, 1999-2017 |
| title_sort | extrahepatic causes of death in cirrhosis compared to other chronic conditions in the united states 1999 2017 |
| topic | Chronic liver disease National center for health statistics CHF COPD Mortality APC |
| url | http://www.sciencedirect.com/science/article/pii/S1665268121002647 |
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