Changes in the Global Burden of Chronic Liver Diseases From 2012 to 2017: The Growing Impact of Nonalcoholic Fatty Liver Disease

Chronic hepatitis B virus (HBV), hepatitis C virus (HCV), nonalcoholic fatty liver disease (NAFLD), and alcoholic liver disease (ALD) are main causes of chronic liver disease (CLD). We assessed the global incidence, mortality, and disability-adjusted life-years (DALYs) related to CLD (primary liver cancer [LC] and cirrhosis). We obtained the data from the 2017 Global Burden of Disease (GBD) study. In 2017, there were 2.14 million liver-related deaths (2.06 million-2.30 million), representing 11.4% increase since 2012 (16.0% increase in LC deaths; 8.7% increase in cirrhosis deaths). LC and cirrhosis accounted for 38.3% and 61.7%, respectively, of liver deaths (LC and cirrhosis deaths were related to HBV [39% and 29%]; HCV [29% and 26%]; ALD [16% and 25%]; and NAFLD [8% and 9%]). Between 2012 and 2017, age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized disability-adjusted life-year (ASDALY) rate increased for LC from 11.1 to 11.8, 10.1 to 10.2, and 250.4 to 253.6 per 100,000, respectively. Whereas ASIR for cirrhosis increased from 66.0 to 66.3, ASDR and ASDALY rate decreased from 17.1 to 16.5 and 532.9 to 510.7, respectively. The largest increase in the ASDR for LC occurred in Eastern Europe (annual percent change [APC] = 2.18% [0.89%-3.49%]), whereas the largest decrease occurred in high-income Asia Pacific (APC = -2.88% [-3.58 to -2.18%]). ASDR for LC-NAFLD and ALD increased annually by 1.42% (1.00%-1.83%) and 0.53% (0.08-0.89), respectively, whereas there were no increases for HBV (P = 0.224) and HCV (P = 0.054). ASDR for cirrhosis-NAFLD increased (APC = 0.29% [0.01%-0.59%]) but decreased for ALD (APC = -0.44% [-0.78% to -0.40%]), HCV (APC = -0.50% [-0.81% to -0.18%]), and HBV (APC = -1.43% [-1.71% to -0.40%]). Conclusion: From 2012 to 2017, the global burden of LC and cirrhosis has increased. Viral hepatitis remains the most common cause of liver deaths, and NAFLD is the most rapidly growing contributor to liver mortality and morbidity.