Su1079 Changes in the Incidence and Prevalence of Cirrhosis in the National Veterans Administration Over a Decade: 2002-2012

BACKGROUND: Cirrhosis is associated with a high morbidity and mortality, and is a risk factor for hepatocellular carcinoma. Yet there is limited information regarding the burden of cirrhosis from population-based studies in the U.S. We aimed to determine the annual incidence and prevalence of cirrhosis as well as time trends in the underlying etiology in a national veterans cohort. METHODS: Using the Veterans Administration Corporate Data Warehouse, we calculated the time trends in the annual incidence and prevalence of overall cirrhosis and decompensated cirrhosis between 2002 and 2012. In addition to the overall trends, we also examined the time trends by subgroups based on the underlying etiology for liver disease. We defined cirrhosis on the basis of previously validated ICD-9 code based algorithms. We used direct standardization method to adjust the time trends for changing age of the cohort (where 2002 VA population used as standard), and used joinpoint regression models to determine the magnitude of these time trends (by calculating average annual percentage change (AAPC)). RESULTS: The age-adjusted incidence rates of cirrhosis per 100 persons slightly increased from 0.22 (95% CI 0.21-0.22) in 2002 to 0.23 in 2012 (95% CI 0.23-0.24). The average annual percentage change (AAPC) in the age-adjusted incidence was 1.76% (p<0.05). The age-adjusted prevalence of cirrhosis per 100 persons increased steeply (AAPC=6.75%) from 0.62 (95% CI 0.61-0.63) in 2002 to 1.27 (95% CI 1.26-1.28) in 2010 and then the rate of increase slowed (AAPC=1.69%) between 2010-2012 to 1.36 (95% CI 1.35-1.37) in 2012. The prevalence of decompensated cirrhosis increased in parallel (0.46 in 2002 to 0.72 in 2012 per 100 persons). There were 68,760 and 41,780 patients with a diagnosis of cirrhosis and decompensated cirrhosis, respectively, who received care in VA facilities in 2012. Figures 1 and 2 shows the trends in overall incidence and prevalence of cirrhosis by etiology. HCV was the leading underlying etiology. In 2002, 47% of prevalent cirrhosis cases had HCV; this proportion increased to 53% in 2012. The proportion of cirrhosis patients with alcohol as the underlying etiology fell slightly from 29.8% in 2002 to 26.1% in 2012, whereas those with HBV remained stable at 0.9% to 1.2%. CONCLUSION: The prevalence of cirrhosis and decompensated cirrhosis has increased significantly over the last decade, and the trend is still upwards. Most patients with cirrhosis have underlying HCV, and successful diffusion of treatment may change the future trajectory of cirrhosis burden. Yet, given the existing and large burden of cirrhosis (and its complications), clinicians and healthcare system need to develop strategies targeted to provide timely and effective care to this high-risk patient population.