Trends of Mortality in End-Stage Liver Disease - China, 2008-2020

Xiaoxiao Wang; Huixin Liu; Jinlei Qi; Fangfang Zeng; Lijun Wang; Peng Yin; Feng Liu; Hongbo Li; Yunning Liu; Jiangmei Liu; Lai Wei; Xiaofeng Liang; Yu Wang; Huiying Rao; Maigeng Zhou

doi:10.46234/ccdcw2023.128

Trends of Mortality in End-Stage Liver Disease - China, 2008-2020

China CDC Wkly. 2023 Jul 28;5(30):657-663. doi: 10.46234/ccdcw2023.128.

Authors

Xiaoxiao Wang^{1

2}, Huixin Liu³, Jinlei Qi⁴, Fangfang Zeng^{5

6

7}, Lijun Wang⁴, Peng Yin⁴, Feng Liu^{1

2}, Hongbo Li⁸, Yunning Liu⁴, Jiangmei Liu⁴, Lai Wei⁹, Xiaofeng Liang^{5

6

7}, Yu Wang¹⁰, Huiying Rao^{1

2}, Maigeng Zhou⁴

Affiliations

¹ Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China.
² Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China.
³ Peking University People's Hospital, Department of Clinical Epidemiology and Biostatistics, Beijing, China.
⁴ National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
⁵ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou City, Guangdong Province, China.
⁶ Disease Control and Prevention Institute of Jinan University, Guangzhou City, Guangdong Province, China.
⁷ Jinan University-BioKangtai Vaccine Institute, Jinan University, Guangzhou City, Guangdong Province, China.
⁸ China Center for Economic Research, National School of Development, Peking University, Beijing, China.
⁹ Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
¹⁰ Chinese Foundation for Hepatitis Prevention and Control, Beijing, China.

Abstract

Introduction: Liver cancer and cirrhosis represent the most prevalent forms of end-stage liver diseases (ESLDs). Notably, in China, deaths attributed to ESLDs contribute significantly to the global mortality rate of these disorders. Enhanced comprehension of the mortality profile associated with ESLDs in China could provide crucial insights into intervention prioritization, which could in turn help reduce the overall global burden of these diseases.

Methods: Data were obtained from China's Disease Surveillance Points system. The presentation includes both crude and age-standardized mortality rates, stratified by sex, residential location, and region. Using Joinpoint Regression, trends in annual mortality rates were estimated from the period of 2008 to 2020 and expressed as the average annual percentage change (AAPC).

Results: In 2020, the gross mortality rate of ESLD stood at 30.08 cases per 100,000 individuals. A higher age-standardized ESLD mortality rate was observed in males and rural populations in comparison to their female and urban counterparts, respectively. Noticeably, the highest mortality rates associated with liver cancer and cirrhosis were reported in South and Southwest China, respectively. A positive correlation was noticed between age-specific ESLD mortality rates and advancing age. Interestingly, an annual decrease in the ESLD mortality rate was observed from 2008 to 2020. In urban contexts, the AAPC of cirrhosis was noted to be higher than that of liver cancer.

Conclusions: The mortality rate associated with ESLDs in China decreased between 2008 and 2020. Nevertheless, the death burden attributable to ESLD continues to be alarmingly high. Future initiatives should prioritize the reduction of ESLD mortality in particular populations: males, elderly individuals, and those residing in rural regions of South and Southwest China. The emphasis of future interventions should be placed on antiviral therapy for adults diagnosed with viral hepatitis, and on the prevention of hepatitis B virus (HBV) infection across all demographics.

Keywords: China; cirrhosis; end-stage liver disease; liver cancer; mortality.

Copyright and License information: Editorial Office of CCDCW, Chinese Center for Disease Control and Prevention 2023.

Grants and funding

Supported by the Beijing Natural Science Foundation [No. 7232195] , National Natural Science Foundation of China [No. 81870406, and No. 81602939], Capital’s Funds for Health Improvement and Research [No. 2020-4-4087], Peking University Medicine Sailing Program for Young Scholars’ Scientific & Technological Innovation [No. BMU2023YFJHPY025] and Chinese foundation for hepatitis prevention and control-TianQing liver disease research fund subject [No. TQGB20210139]