Trends in mortality from chronic liver disease

Mortality from liver cirrhosis has sharply declined in most countries in the last few decades, but includes only a fraction of deaths due to chronic liver disease.

Mortality records for liver cirrhosis, liver cancer, viral hepatitis, and the three disease categories combined were extracted for the period 1995 to 2010 in the Veneto Region (northeastern Italy). The presence of a birth cohort effect was assessed by fitting Poisson regression models. The alcoholic or viral etiology was retrieved through multiple causes of death analysis for the years 2008 to 2010.

Liver cirrhosis mortality represented only one-third of all liver disease deaths; this proportion was even smaller for deaths with a viral etiology and among elderly people. Through the study period, age-standardized rates declined by 50% for liver cirrhosis, and by 30% (world standard) or by 25% (regional standard) for all liver diseases; the reduction in proportional mortality was limited to 11%. Mortality rates started to decline in subjects born after the early 1920s.

The decline in mortality was smaller than that reported by standard statistics for chronic liver disease; these statistics should routinely include viral hepatitis and liver cancer deaths. When available, multiple causes of death data should be analyzed.