Trends in Burden of Cirrhosis and Hepatocellular Carcinoma by Underlying Liver Disease in US Veterans, 2001-2013
Trends in Burden of Cirrhosis and Hepatocellular Carcinoma by Underlying Liver Disease in US Veterans, 2001-2013
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2001-2013 年美国退伍军人肝硬化和肝细胞癌负担趋势（按肝脏疾病分类
DOI：
10.1053/j.gastro.2015.07.056
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发表时间：
2015-11-01
期刊：
影响因子：
29.4
通讯作者：
Ioannou, George N.
中科院分区：
文献类型：
--
作者：
Beste, Lauren A.;Leipertz, Steven L.;Ioannou, George N.
背景与目的：在美国，肝硬化和肝细胞癌（HCC）预计会增加，但先前预测的准确性以及各种肝脏疾病病因的影响仍不清楚。我们旨在确定2001年至2013年根据潜在病因划分的肝硬化和HCC的负担。
方法：我们建立了一个全国性的退伍军人事务部（VA）回顾性队列，纳入2001年至2013年被诊断为肝硬化（n = 129,998）或HCC（n = 21,326）的患者。我们利用实验室结果、国际疾病分类第九版（ICD - 9）编码以及体重指数来确定潜在病因。
结果：2013年，VA为5,720,614人提供医疗服务，其中60,553人（1.06%）患有肝硬化，7,670人（0.13%）患有HCC。2001年至2013年期间，丙型肝炎病毒（HCV）在肝硬化和HCC中所占比例不断增加，到2013年，在肝硬化病例和死亡病例中占48%，在HCC病例和死亡病例中占67%。从2001年到2013年，肝硬化患病率几乎翻倍（每10万名参保人从664人增加到1058人），这是由HCV和非酒精性脂肪性肝病（NAFLD）导致的。肝硬化发病率在每10万人 - 年159到193人之间。肝硬化患者的死亡率从每10万人 - 年83人增加到126人，主要由HCV导致。HCC发病率从每10万人 - 年17人增加到45人，增加了2.5倍。HCC死亡率从每10万人 - 年13人增加到37人，增加了两倍，主要由HCV导致，NAFLD和酒精性肝病的影响要小得多。
结论：从2001年到2013年，肝硬化患病率和死亡率以及HCC发病率和死亡率增加，主要由HCV驱动，NAFLD的影响较小。如果目前的趋势继续下去，肝硬化患病率将在2021年达到峰值。医疗保健系统将需要容纳越来越多的肝硬化和HCC患者。
BACKGROUND & AIMS: Cirrhosis and hepatocellular carcinoma (HCC) are predicted to increase in the United States but the accuracy of prior forecasts and the contributions from various liver disease etiologies remain unclear. We aimed to determine the burden of cirrhosis and HCC according to underlying cause from 2001 to 2013. METHODS: We developed a national retrospective cohort of Veterans Affairs (VA) patients with the diagnosis of cirrhosis (n 129,998) or HCC (n = 21,326) from 2001 to 2013. We used laboratory results, International Classification of Diseases, ninth edition (ICD-9) codes, and body mass index to identify underlying etiologies. RESULTS: In 2013, VA provided care to 5,720,614 individuals, of whom 60,553 (1.06%) had cirrhosis and 7,670 (0.13%) had HCC. Hepatitis C virus (HCV) was present in an increasing proportion of cirrhosis and HCC between 2001 and 2013, reaching 48% of cirrhosis cases and deaths and 67% of HCC cases and deaths by 2013. Cirrhosis prevalence nearly doubled from 2001 to 2013 (664 to 1058 per 100,000 enrollees), driven by HCV and nonalcoholic fatty liver disease (NAFLD). Cirrhosis incidence ranged from 159 to 193 per 100,000 patient-years. Deaths in patients with cirrhosis increased from 83 to 126 per 100,000 patient-years, largely driven by HCV. HCC incidence was 2.5-fold increased from 17 to 45 per 100,000 patient-years. HCC mortality tripled from 13 to 37 per 100,000 patient-years, driven overwhelmingly by HCV, with much smaller contributions from NAFLD and alcoholic liver disease. CONCLUSIONS: Cirrhosis prevalence and mortality and HCC incidence and mortality increased from 2001 to 2013, driven by HCV, with a smaller contribution from NAFLD. If current trends continue, cirrhosis prevalence will peak in 2021. Health care systems will need to accommodate rising numbers of patients with cirrhosis and HCC.