Incidence, aetiology and related comorbidities of cirrhosis: a Swedish population-based cohort study

Abstract

Background: The incidence of cirrhosis for individuals in Sweden has previously been reported as stable/low among European countries. However, Swedish population-based studies are scarce and none of them included data from the most recent decade (2010-2019). We aimed to describe the incidence and aetiology of cirrhosis in the Halland region from 2011 to 2018, and to describe the severity and prevalence of liver-related complications and other primary comorbidities at the time of cirrhosis diagnosis. Methods: We conducted a retrospective cohort study of all patients with cirrhosis in Halland, which has a population of 310,000 inhabitants. Medical records and histopathology registries were reviewed. Results: A total of 598 patients with cirrhosis were identified. The age-standardised incidence was estimated at 23.2 per 100,000 person-years (95% CI 21.3-25.1), 30.5 (95% CI 27.5-33.8) for men and 16.4 (95% CI 14.3-18.7) for women. When stratified by age, the highest incidence rates were registered at age 60-69 years. Men had a higher incidence rate for most age groups when compared to women. The most common aetiology was alcohol (50.5%), followed by cryptogenic cirrhosis (14.5%), hepatitis C (13.4%), and non-alcoholic fatty liver disease (5.7%). Most patients had at least one liverrelated complication at diagnosis (68%). The most common comorbidities at diagnosis were arterial hypertension (33%), type 2 diabetes (29%) and obesity (24%). Conclusions: Based on previous Swedish studies, our results indicate that the incidence of cirrhosis in Sweden might be considerably higher than previously reported. It is uncertain if the incidence of cirrhosis has previously been underestimated or if an actual increment has occurred during the course of the most recent decade. The increased incidence rates of cirrhosis reported in Halland are multifactorial and most likely related to higher incidence rates among the elderly. Preobesity and obesity are common in cirrhosis and non-alcoholic fatty liver disease has become an important cause of cirrhosis in Halland.

Spectrum of hepatic encephalopathy admitted in a tertiary care center

“…[11] In a study from Sweden, alcohol was most common and constituted 50.5% of all etiologies of liver cirrhosis. [12] Alcohol-related liver cirrhosis predominated in our study also. Multiple studies have given a similar alcohol predominant etiology for liver cirrhosis.…”

Socioeconomic and marital status among liver cirrhosis patients and associations with mortality: a population-based cohort study in Sweden

“…This study is based on a cohort described earlier in detail [6], which was retrieved by a systematic inventory of cirrhosis data in a well-defined Swedish population. Essentially, a broad search was performed for all patients with cirrhosis diagnosed in the Region of Halland (310,665 inhabitants, year 2014) between January 1st 2011 and December 31st 2018 [6].…”

“…The search was conducted using a wide array of cirrhosis-related International Classification of Diseases 10th Revision -Swedish Edition (ICD-10-SE) codes (Supplementary Material 1) [6]. The use of ICD-10-SE has been mandatory in Sweden since January 1st 2011 and, according to the Swedish National Board of Health and Welfare, none of the codes described in the supplementary material have been changed since then [23].…”

“…The use of ICD-10-SE has been mandatory in Sweden since January 1st 2011 and, according to the Swedish National Board of Health and Welfare, none of the codes described in the supplementary material have been changed since then [23]. In addition, patient data were retrieved from the pathology registry using the Systemized Nomenclature of Medicine (SNOMED) codes for liver (T-56), cirrhosis (M-495), and HCC (M-817) as described elsewhere [5,6]. SNOMED is an international nomenclature system that is broadly used in pathology [24].…”

“…It is the main risk factor for hepatocellular cancer (HCC) [2], and it is also the leading indicator for liver transplantation in Europe [3]. Alcohol overconsumption and chronic hepatitis C infection (HCV) are the main causes of cirrhosis in Sweden [4][5][6].…”