Abstract
Chronic liver disease is a common cause of morbidity and mortality in the United States. The most common causes of liver disease include non-alcoholic fatty liver disease (NAFLD), chronic hepatitis C virus infection, alcoholic liver disease, and chronic hepatitis B virus infection. Through a discussion of various surveillance methods as well as their strengths and weaknesses, we review the epidemiology, risk factors, and natural history of each of these diseases and discuss prevention measures that have been effective in decreasing incidence rates.
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Summary Table of Landmark Literature
Summary Table of Landmark Literature
Study title and authors | Study design | Summary results | Main limitations |
---|---|---|---|
Younossi, ZM, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clinical Gastroenterology & Hepatology. 2011;9(6):524ā30. | Repeated cross-sectional surveys using NHANES to determine trends in the etiologies of chronic liver disease in the United States from 1988 to 2008. | ā¢āPrevalence of HCV has remained stable ā¢āPrevalence of alcoholic liver disease has remained stable ā¢āNAFLD has increase in prevalence from 5.5% in 1988ā1994 to 11.0% in 2005ā2008 | ā¢āNHANES only captures non-institutionalized adults ā¢āImmigrants, incarcerated persons, those in hospital or nursing homes, and the homeless are underrepresented |
Bell BP, et al. The epidemiology of newly diagnosed chronic liver disease in gastroenterology practices in the United States: results from population-based surveillance. American Journal of Gastroenterology. 2008;103(11):2727ā36 | Prospective study of patients newly diagnosed with chronic liver disease in specialty offices (gastroenterology and hepatology). Patients underwent a chart review, interview, and additional viral hepatitis testing | ā¢āYearly incidence rate was 63.9/100,000 population between 1999 and 2001 ā¢ā42% were related to hepatitis C, 22% to hepatitis C and alcohol, 9% related to non-alcoholic liver disease, 8% from alcohol alone, and 3% to hepatitis B ā¢ā18% presented with cirrhosis | ā¢āReferral population ā¢ā49% of eligible patients participated ā¢āThree geographical areas in the United States were included ā¢āPatients with HIV infection were excluded |
Lazo M, et al. Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988ā1994. American Journal of Epidemiology. 2013;178(1):38ā45. | Cross-sectional study using ultrasonography in the diagnosis of nonalcoholic fatty liver | ā¢āPrevalence of NAFLD was 19.0% ā¢ā28.8Ā million adults estimated to have NAFLD nationwide ā¢āMore common in Mexican-Americans and in men compared with women ā¢āIndependently associated with diabetes, insulin resistance dyslipidemia, and with obesity | ā¢āCross-sectional so could not define causality ā¢āUnable to detect inflammation as used ultrasound alone ā¢āData are 20Ā years old |
Goldstein ST, Alter MJ, Williams IT, Moyer LA, Judson FN, Mottram K, et al. Incidence and risk factors for acute hepatitis B in the United States, 1982ā1998: implications for vaccination programs. J Infect Dis. 2002;185(6):713ā9. | Cross-sectional analysis of patient data from county-based health department reports of HBV infection in four U.S. counties from 1982 to 1998. | ā¢āIncidence of HBV decreased from 13.5/100,000 persons initially in 1982 to 3.3/100,000 by 1998 ā¢āIndividuals aged 10ā19Ā years old had the greatest decline in incidence (72.5%) | ā¢āData are 20Ā years old |
Roberts H, Kruszon-Moran D, Ly KN, Hughes E, Iqbal K, Jiles RB, et al. Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988ā2012. Hepatology. 2016;63(2):388ā97 | Repeated cross-sectional surveys of NHANES data assessing the prevalence of hepatitis B in the United States from 1988 through 2012. | ā¢āOverall prevalence of chronic HBV infection was found to be fairly constant over the last two decades at approximately 0.3% ā¢ā3.1% of non-Hispanic Asians had chronic HBV infection, tenfold higher than the general population; non-Hispanic black individuals had a prevalence two- to threefold higher than the general population ā¢āIn 6ā19Ā year olds, prevalence of chronic HBV decreased from 0.24% in 1988ā1994 to 0.05% in 1999ā2006 | ā¢āNHANES only captures non-institutionalized adults ā¢āImmigrants, incarcerated persons, those in hospital or nursing homes, and the homeless are underrepresented |
Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Teo CG, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945ā1965. MMWR Recommendations and reports: Morbidity and mortality weekly report Recommendations and reports. 2012;61(RR-4):1ā32 | Systematic Review. Guidelines based upon multiple population-based epidemiologic studies (mostly NHANES) on the prevalence of HCV by age corhort | ā¢āIndividuals born between 1945 and 1965 have a threefold higher prevalence of HCV infection compared to the general population. Approximately 75% of individuals with chornic HCV infection were born during this time ā¢āCDC recommends one-time HCV screening of all individuals in this birth cohort | ā¢āNHANES only captures non-institutionalized adults ā¢āImmigrants, incarcerated persons, those in hospital or nursing homes, and the homeless are underrepresented |
Denniston MM, Jiles RB, Drobeniuc J, Klevens RM, Ward JW, McQuillan GM et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med. 2014;160(5):293ā300. | Repeated cross-sectional surveys using NHANES to determine trends in hepatitis C incidence and prevalence in the United States | ā¢āChronic HCV infection affects approximately 1% of the U.S. population, or an estimated 2.7 million people ā¢āIndividuals who use IV drugs, or who received blood transfusions prior 1992 were more likely to be infected than the general population | ā¢āNHANES only captures non-institutionalized adults ā¢āImmigrants, incarcerated persons, those in hospital or nursing homes, and the homeless are underrepresented |
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Yang, Y., Luk, J., Sofair, A.N. (2019). Epidemiology of Chronic Liver Disease in theĀ United States. In: Wong, R., Gish, R. (eds) Clinical Epidemiology of Chronic Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-94355-8_6
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