Abstract
Background
It is estimated that 1 in 4 Canadians have chronic liver disease and are at risk of developing cirrhosis. There is a paucity of population-based studies examining the temporal trends in the burden of cirrhosis in North America.
Aims
To describe secular trends in the epidemiology of cirrhosis in Ontario, Canada over the past two decades.
Methods
This is a retrospective population-based cohort study of patients with cirrhosis in Ontario from 1992–2012 using data from the Institute of Comparative Evaluative Sciences. Follow-up was until December 31, 2015. Individuals with cirrhosis were identified using validated administrative coding algorithms. Data on demographics and survival were defined using linked administrative datasets. Annual adjusted incidence and prevalence rates were calculated standardizing to the 1991 Canadian population stratifying on age and sex. Comparison between rates was done using Poisson regression.
Results
A total of 178,152 patients with cirrhosis were included. Median age at diagnosis was 56 years (IQR 45–67 years), 61.6% male with 53% dying over a median follow-up of 5.2 years (IQR 1.5–11.4 years). The adjusted incidence rate did not change over the study period with an average rate of 10.4/10,000 (P = 0.43, figure). However, there was a significant rise in the adjusted prevalence with the rate increasing from 20.7/10,000 in 1992 vs. 120/10,000 in 2012 (P <.001, figure) representing an almost 6-fold increase. The growth in disease burden was higher in men than in women (P <.001) with the majority occurring in males over the age of 55 years and the most dramatic increase in men over the age of 80 years (prevalence rate 56.2/10,000 in 1992 vs. 419.4/10,000 in 2012, P <.001).
Conclusions
The burden of cirrhosis in Ontario has increased at a rapid rate over the last two decades likely due to the aging hepatitis C population and the epidemic of fatty liver disease while at the same time is becoming a disease of the elderly men. These results support the urgent need for both a national hepatitis C and liver strategy in attempt to reverse these trends.
Funding Agencies
None