Here we report on results from the Global Burden of Diseases, Risk Factors, and Injuries Study (GBD) 2017 on the burden of cirrhosis and its trend since 1990, by sex and age, for 195 countries and territories.

GBD methods

Globally, cirrhosis caused 1 322 868 (95% uncertainty interval [UI] 1 268 197–1 449 133) deaths in both sexes combined in 2017, compared to 898 991 (828 934–948 209) deaths in 1990. Despite an increase in counts, the age-standardised death rate (ASDR) decreased from 21·0 (19·2–22·3) per 100 000 in 1990 to 16·5 (15·8–18·1) per 100 000 in 2017. The ASDR was highest in sub-Saharan Africa and lowest in the high-income super-region. ASDR decreased in all GBD regions between 1990 and 2017 except for eastern Europe and central Asia. ASDR of cirrhosis was lowest in Singapore in 2017 and highest in Egypt in all years since 1990. In 2017, there were 10·6 million (10·3–11·0) prevalent cases of decompensated and 112·4 million (106·6–118·5) prevalent cases of compensated cirrhosis worldwide. The highest proportion of deaths and prevalent cases of both types was due to hepatitis B in both sexes. A higher proportion of prevalent cases were due to alcoholic liver disease (ALD) compared to deaths. Globally, non-alcoholic steatohepatitis (NASH) was the only aetiology that had a steady ASDR throughout the study period, while the other four aetiologies showed declines in ASDR. There was an increase in the age-standardised prevalence of NASH. The number of prevalent cases of decompensated and compensated cirrhosis due to NASH increased more than three times and two times, respectively, from 1990 to 2017.

Cirrhosis imposes burden on nations. Effective interventions are required to continue prevention and treatment of viral hepatitis, ALD, and NASH, and their early diagnosis and prevention.