NAFLD and Alcohol-Associated Liver Disease Will Be Responsible for Almost All New Diagnoses of Cirrhosis in Canada by 2040.

Background & aims Mortality secondary to cirrhosis in North America is increasing. We describe the incidence of cirrhosis stratified by birth cohort and cirrhosis etiology and project disease burden to 2040. Approach & results Retrospective cohort study in Ontario, Canada using population-based administrative healthcare data. Individuals with incident cirrhosis (2000-2017) were identified and etiology was defined as hepatitis C (HCV), hepatitis B, non-alcoholic fatty liver disease (NAFLD), alcohol-related disease (ALD) or autoimmune liver disease/Other using validated case definitions. Annual age/sex adjusted cirrhosis incidence rate per 100,000 person-years (PY) was calculated with incidence projection to 2040 using age-period-cohort modeling along with average annual percent change (AAPC) in cirrhosis incidence stratified by birth cohort and etiology. 159, 549 incident cases of cirrhosis were identified. Incidence increased by 26% with an AAPC of 2%/year (95% CI 1.6-2.4, P 1980 increased by 11.6%/year (95% CI 9.3-13.9, P 1980. Conclusions Cirrhosis incidence will continue to increase over the next two decades secondary to NAFLD with a worrisome rapid rise in ALD cirrhosis among young adults. Public education, policy, and intervention targeting NAFLD risk factors and alcohol use in young adults are urgently needed.