Global Epidemiology of Chronic Liver Disease

  • Nimzing Gwamzhi LadepEmail author
  • Sheikh Mohammad Fazle Akbar
  • Mamun Al Mahtab


This chapter provides a global summary of the epidemiology of chronic liver disease. The synopsis presented here regards the pattern of chronic liver disease in sub-Saharan Africa, Asia, Europe and Latin America.

Electronic search engines were employed and papers published in the English language were reviewed during the write up process. The search words included: “rates” AND “prevalence” AND “epidemiology” AND “liver diseases” OR “HBV” OR “HCV”. Data were summarised in maps and tables for ease of understanding and landmark papers used during the review process were highlighted in a table.

Whereas alcohol is the most important factor associated with chronic liver disease in most developed industrialised countries of the world, viral hepatitis B (HBV) is the most common factor in sub-Saharan Africa and Asia. Eastern European countries have recorded high rates of HBV infection as well. Of the viral factors, hepatitis C virus (HCV) is the most common cause of chronic liver disease in Europe, although, the prevalence of HCV in some developing countries have been recorded to be higher than obtainable in Europe. Non-alcoholic fatty liver disease is increasingly being implicated as the cause of chronic liver disease in all regions of the world.


  1. 1.
    Ladep NG, Lesi OA, Mark P, Lemoine M, Onyekwere C, Afihene M, et al. Problem of hepatocellular carcinoma in West Africa. World J Hepatol. 2014;6(11):783–92.CrossRefGoogle Scholar
  2. 2.
    Taye S, Abdulkerim A, Hussen M. Prevalence of hepatitis B and C virus infections among patients with chronic hepatitis at Bereka Medical Center, Southeast Ethiopia: a retrospective study. BMC Res Notes. 2014;7:272.CrossRefGoogle Scholar
  3. 3.
    Ofori-Asenso R, Agyeman AA. Hepatitis B in Ghana: a systematic review & meta-analysis of prevalence studies (1995–2015). BMC Infect Dis. 2016;16:130.CrossRefGoogle Scholar
  4. 4.
    Motayo BO, Faneye AO, Udo UA, Olusola BA, Ezeani I, Ogiogwa JI. Seroprevalence of transfusion transmissible infections (TTI), in first time blood donors in Abeokuta, Nigeria. Afr Health Sci. 2015;15(1):19–24.CrossRefGoogle Scholar
  5. 5.
    Kateera F, Walker TD, Mutesa L, Mutabazi V, Musabeyesu E, Mukabatsinda C, et al. Hepatitis B and C seroprevalence among health care workers in a tertiary hospital in Rwanda. Trans R Soc Trop Med Hyg. 2015;109(3):203–8.CrossRefGoogle Scholar
  6. 6.
    Ochola E, Ocama P, Orach CG, Nankinga ZK, Kalyango JN, McFarland W, et al. High burden of hepatitis B infection in Northern Uganda: results of a population-based survey. BMC Public Health. 2013;13:727.CrossRefGoogle Scholar
  7. 7.
    Namululi BA, Guerrieri C, Dramaix MW. Prevalence and incidence of HIV and hepatitis B among blood donors and estimated residual risk of transmission of HIV and HBV virus by blood transfusion. A study at the Provincial General Referee Hospital Bukavu, Democratic Republic of the Congo. Rev Epidemiol Sante Publique. 2013;61(2):139–44.CrossRefGoogle Scholar
  8. 8.
    Noubiap JJ, Joko WY, Nansseu JR, Tene UG, Siaka C. Sero-epidemiology of human immunodeficiency virus, hepatitis B and C viruses, and syphilis infections among first-time blood donors in Edea, Cameroon. Int J Infect Dis. 2013;17(10):e832–7.CrossRefGoogle Scholar
  9. 9.
    Muchiri I, Okoth FA, Ngaira J, Tuei S. Seroprevalence of Hav, Hbv, Hcv, and Hev among acute hepatitis patients at Kenyatta National Hospital in Nairobi, Kenya. East Afr Med J. 2012;89(6):199–205.PubMedGoogle Scholar
  10. 10.
    Abou MA, Eltahir YM, Ali AS. Seroprevalence of hepatitis B virus and hepatitis C virus among blood donors in Nyala, South Dar Fur, Sudan. Virol J. 2009;6:146.CrossRefGoogle Scholar
  11. 11.
    Fasola FA, Kotila TR, Akinyemi JO. Trends in transfusion-transmitted viral infections from 2001 to 2006 in Ibadan, Nigeria. Intervirology. 2008;51(6):427–31.CrossRefGoogle Scholar
  12. 12.
    Okoth F, Mbuthia J, Gatheru Z, Murila F, Kanyingi F, Mugo F, et al. Seroprevalence of hepatitis B markers in pregnant women in Kenya. East Afr Med J. 2006;83(9):485–93.PubMedGoogle Scholar
  13. 13.
    Pido B, Kagimu M. Prevalence of hepatitis B virus (HBV) infection among Makerere University medical students. Afr Health Sci. 2005;5(2):93–8.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Abebe A, Nokes DJ, Dejene A, Enquselassie F, Messele T, Cutts FT. Seroepidemiology of hepatitis B virus in Addis Ababa, Ethiopia: transmission patterns and vaccine control. Epidemiol Infect. 2003;131(1):757–70.CrossRefGoogle Scholar
  15. 15.
    Sirisena ND, Njoku MO, Idoko JA, Isamade E, Barau C, Jelpe D, et al. Carriage rate of hepatitis-B surface antigen (HBsAg) in an urban community in Jos, Plateau State, Nigeria. Niger Postgrad Med J. 2002;9(1):7–10.PubMedGoogle Scholar
  16. 16.
    Gaobepe M, Aspinall S, Bos P. Hepatitis B viral markers in Bushmen at Schmidtsdrift, South Africa: baseline studies for immunisation. East Afr Med J. 1995;72(7):421–3.PubMedGoogle Scholar
  17. 17.
    Pellizzer G, Ble C, Zamperetti N, Stroffolini T, Upunda G, Rapicetta M, et al. Serological survey of hepatitis B infection in Tanzania. Public Health. 1994;108(6):427–31.CrossRefGoogle Scholar
  18. 18.
    Harry TO, Bajani MD, Moses AE. Hepatitis B virus infection among blood donors and pregnant women in Maiduguri, Nigeria. East Afr Med J. 1994;71(9):596–7.PubMedGoogle Scholar
  19. 19.
    Aspinall S, Joubert JJ, Evans AC, Joseph S, Steele AD, Lecatsas G. Prevalence of hepatitis B in !Kung (San) children from Bushmanland, Namibia. Ann Trop Paediatr. 1994;14(2):163–7.CrossRefGoogle Scholar
  20. 20.
    Opio CK, Seremba E, Ocama P, Lalitha R, Kagimu M, Lee WM. Diagnosis of alcohol misuse and alcoholic liver disease among patients in the medical emergency admission service of a large urban hospital in Sub-Saharan Africa; a cross sectional study. Pan Afr Med J. 2013;15:23.CrossRefGoogle Scholar
  21. 21.
    Ndububa DA, Ojo OS, Adetiloye VA, Aladegbaiye AO, Adebayo RA, Adekanle O. The contribution of alcohol to chronic liver disease in patients from South-west Nigeria. Niger J Clin Pract. 2010;13(4):360–4.PubMedGoogle Scholar
  22. 22.
    Okeke EN, Malu AO, Obafunwa JO, Nwana EJ. Aetiological significance of alcohol in liver cirrhosis on the Jos Plateau. West Afr J Med. 2002;21(1):12–4.PubMedGoogle Scholar
  23. 23.
    Almobarak AO, Barakat S, Suliman EA, Elmadhoun WM, Mohamed NA, Abobaker IO, et al. Prevalence of and predictive factors for nonalcoholic fatty liver disease in Sudanese individuals with type 2 diabetes: Is metabolic syndrome the culprit? Arab J Gastroenterol. 2015;16(2):54–8.CrossRefGoogle Scholar
  24. 24.
    Almobarak AO, Barakat S, Khalifa MH, Elhoweris MH, Elhassan TM, Ahmed MH. Non alcoholic fatty liver disease (NAFLD) in a Sudanese population: What is the prevalence and risk factors? Arab J Gastroenterol. 2014;15(1):12–5.CrossRefGoogle Scholar
  25. 25.
    Onyekwere CA, Ogbera AO, Balogun BO. Non-alcoholic fatty liver disease and the metabolic syndrome in an urban hospital serving an African community. Ann Hepatol. 2011;10(2):119–24.PubMedGoogle Scholar
  26. 26.
    Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012;30(12):2212–9.CrossRefGoogle Scholar
  27. 27.
    Wang FS, Fan JG, Zhang Z, Gao B, Wang HY. The global burden of liver disease: the major impact of China. Hepatology. 2014;60(6):2099–108.CrossRefGoogle Scholar
  28. 28.
    Cui Y, Jia J. Update on epidemiology of hepatitis B and C in China. J Gastroenterol Hepatol. 2013;28(Suppl 1):7–10.CrossRefGoogle Scholar
  29. 29.
    Luo Z, Li L, Ruan B. Impact of the implementation of a vaccination strategy on hepatitis B virus infections in China over a 20-year period. Int J Infect Dis. 2012;16(2):e82–8.CrossRefGoogle Scholar
  30. 30.
    Batham A, Gupta MA, Rastogi P, Garg S, Sreenivas V, Puliyel JM. Calculating prevalence of hepatitis B in India: using population weights to look for publication bias in conventional meta-analysis. Indian J Pediatr. 2009;76(12):1247–57.CrossRefGoogle Scholar
  31. 31.
    Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol. 2014;61(1 Suppl):S45–57.CrossRefGoogle Scholar
  32. 32.
    Bellentani S, Scaglioni F, Marino M, Bedogni G. Epidemiology of non-alcoholic fatty liver disease. Dig Dis. 2010;28(1):155–61.CrossRefGoogle Scholar
  33. 33.
    Gu D, Reynolds K, Wu X, Chen J, Duan X, Reynolds RF, et al. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet. 2005;365(9468):1398–405.CrossRefGoogle Scholar
  34. 34.
    Fan JG, Zhu J, Li XJ, Chen L, Lu YS, Li L, et al. Fatty liver and the metabolic syndrome among Shanghai adults. J Gastroenterol Hepatol. 2005;20(12):1825–32.CrossRefGoogle Scholar
  35. 35.
    Borie F, Tretarre B, Bouvier AM, Faivre J, Binder F, Launoy G, et al. Primitive liver cancers: epidemiology and geographical study in France. Eur J Gastroenterol Hepatol. 2009;21(9):984–9.CrossRefGoogle Scholar
  36. 36.
    Parna K, Rahu K. Dramatic increase in alcoholic liver cirrhosis mortality in Estonia in 1992-2008. Alcohol Alcohol. 2010;45(6):548–51.CrossRefGoogle Scholar
  37. 37.
    Jepsen P, Vilstrup H, Andersen PK, Lash TL, Sorensen HT. Comorbidity and survival of Danish cirrhosis patients: a nationwide population-based cohort study. Hepatology. 2008;48(1):214–20.CrossRefGoogle Scholar
  38. 38.
    Quoilin S, Hutse V, Vandenberghe H, Claeys F, Verhaegen E, De Cock L, et al. A population-based prevalence study of hepatitis A, B and C virus using oral fluid in Flanders, Belgium. Eur J Epidemiol. 2007;22(3):195–202.CrossRefGoogle Scholar
  39. 39.
    Gheorghe L, Iacob S, Csiki IE. Prevalence of hepatitis C in Romania: different from European rates? J Hepatol. 2008;49(4):661–2. author reply 663CrossRefGoogle Scholar
  40. 40.
    Demetriou VL, van de Vijver DA, Hezka J, Kostrikis LG, Cyprus IVDU Network, Kostrikis LG. Hepatitis C infection among intravenous drug users attending therapy programs in Cyprus. J Med Virol. 2010;82(2):263–70.CrossRefGoogle Scholar
  41. 41.
    Jauffret-Roustide M, Le Strat Y, Couturier E, Thierry D, Rondy M, Quaglia M, et al. A national cross-sectional study among drug-users in France: epidemiology of HCV and highlight on practical and statistical aspects of the design. BMC Infect Dis. 2009;9:113.CrossRefGoogle Scholar
  42. 42.
    Muhlberger N, Schwarzer R, Lettmeier B, Sroczynski G, Zeuzem S, Siebert U. HCV-related burden of disease in Europe: a systematic assessment of incidence, prevalence, morbidity, and mortality. BMC Public Health. 2009;9:34.CrossRefGoogle Scholar
  43. 43.
    Esteban JI, Sauleda S, Quer J. The changing epidemiology of hepatitis C virus infection in Europe. J Hepatol. 2008;48(1):148–62.CrossRefGoogle Scholar
  44. 44.
  45. 45.
    Rizzetto M. Hepatitis D: thirty years after. J Hepatol. 2009;50(5):1043–50.CrossRefGoogle Scholar
  46. 46.
    Tsatsralt-Od B, Takahashi M, Endo K, Buyankhuu O, Baatarkhuu O, Nishizawa T, et al. Infection with hepatitis A, B, C, and delta viruses among patients with acute hepatitis in Mongolia. J Med Virol. 2006;78(5):542–50.CrossRefGoogle Scholar
  47. 47.
    Borresen ML, Olsen OR, Ladefoged K, McMahon BJ, Hjuler T, Panum I, et al. Hepatitis D outbreak among children in a hepatitis B hyper-endemic settlement in Greenland. J Viral Hepat. 2010;17(3):162–70.CrossRefGoogle Scholar
  48. 48.
    Flodgren E, Bengtsson S, Knutsson M, Strebkova EA, Kidd AH, Alexeyev OA, et al. Recent high incidence of fulminant hepatitis in Samara, Russia: molecular analysis of prevailing hepatitis B and D virus strains. J Clin Microbiol. 2000;38(9):3311–6.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Gastaldelli A, Kozakova M, Hojlund K, Flyvbjerg A, Favuzzi A, Mitrakou A, et al. Fatty liver is associated with insulin resistance, risk of coronary heart disease, and early atherosclerosis in a large European population. Hepatology. 2009;49(5):1537–44.CrossRefGoogle Scholar
  50. 50.
    Targher G, Bertolini L, Padovani R, Rodella S, Tessari R, Zenari L, et al. Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care. 2007;30(5):1212–8.CrossRefGoogle Scholar
  51. 51.
    Williamson RM, Price JF, Hayes PC, Glancy S, Frier BM, Johnston GI, et al. Prevalence and markers of advanced liver disease in type 2 diabetes. QJM. 2012;105(5):425–32.CrossRefGoogle Scholar
  52. 52.
    Dyson J, Jaques B, Chattopadyhay D, Lochan R, Graham J, Das D, et al. Hepatocellular cancer: the impact of obesity, type 2 diabetes and a multidisciplinary team. J Hepatol. 2014;60(1):110–7.CrossRefGoogle Scholar
  53. 53.
    Fairbanks KD, Tavill AS. Liver disease in alpha 1-antitrypsin deficiency: a review. Am J Gastroenterol. 2008;103(8):2136–41. quiz 2142CrossRefGoogle Scholar
  54. 54.
    Francque S, Vonghia L, Ramon A, Michielsen P. Epidemiology and treatment of autoimmune hepatitis. Hepat Med. 2012;4:1–10.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Alvarado-Mora MV, Pinho JR. Epidemiological update of hepatitis B, C and delta in Latin America. Antivir Ther. 2013;18(3 Pt B):429–33.PubMedGoogle Scholar
  56. 56.
    Zampino R, Boemio A, Sagnelli C, Alessio L, Adinolfi LE, Sagnelli E, et al. Hepatitis B virus burden in developing countries. World J Gastroenterol. 2015;21(42):11,941–53.CrossRefGoogle Scholar
  57. 57.
    Tanaka J. Hepatitis B epidemiology in Latin America. Vaccine. 2000;18(Suppl 1):S17–9.CrossRefGoogle Scholar
  58. 58.
    Roman S, Jose-Abrego A, Fierro NA, Escobedo-Melendez G, Ojeda-Granados C, Martinez-Lopez E, et al. Hepatitis B virus infection in Latin America: a genomic medicine approach. World J Gastroenterol. 2014;20(23):7181–96.CrossRefGoogle Scholar
  59. 59.
    Roman S, Panduro A, Aguilar-Gutierrez Y, Maldonado M, Vazquez-Vandyck M, Martinez-Lopez E, et al. A low steady HBsAg seroprevalence is associated with a low incidence of HBV-related liver cirrhosis and hepatocellular carcinoma in Mexico: a systematic review. Hepatol Int. 2009;3(2):343–55.CrossRefGoogle Scholar
  60. 60.
    Roman S, Tanaka Y, Khan A, Kurbanov F, Kato H, Mizokami M, et al. Occult hepatitis B in the genotype H-infected Nahuas and Huichol native Mexican population. J Med Virol. 2010;82(9):1527–36.CrossRefGoogle Scholar
  61. 61.
    Livingston SE, Simonetti JP, McMahon BJ, Bulkow LR, Hurlburt KJ, Homan CE, et al. Hepatitis B virus genotypes in Alaska Native people with hepatocellular carcinoma: preponderance of genotype F. J Infect Dis. 2007;195(1):5–11.CrossRefGoogle Scholar
  62. 62.
    Roman S, Panduro A. HBV endemicity in Mexico is associated with HBV genotypes H and G. World J Gastroenterol. 2013;19(33):5446–53.CrossRefGoogle Scholar
  63. 63.
    Leon B, Taylor L, Vargas M, Luftig RB, Albertazzi F, Herrero L, et al. HBx M130K and V131I (T-A) mutations in HBV genotype F during a follow-up study in chronic carriers. Virol J. 2005;2:60.CrossRefGoogle Scholar
  64. 64.
    Weissenbacher M, Rossi D, Radulich G, Sosa-Estani S, Vila M, Vivas E, et al. High seroprevalence of bloodborne viruses among street-recruited injection drug users from Buenos Aires, Argentina. Clin Infect Dis. 2003;37(Suppl 5):S348–52.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Nimzing Gwamzhi Ladep
    • 1
    • 2
    • 3
    • 4
    Email author
  • Sheikh Mohammad Fazle Akbar
    • 5
  • Mamun Al Mahtab
    • 6
  1. 1.Arrowe Park HospitalWirral University Teaching Hospital NHS Foundation TrustUptonUK
  2. 2.Imperial College LondonLondonUK
  3. 3.Jos University Teaching HospitalJosNigeria
  4. 4.University of JosJosNigeria
  5. 5.Toshiba General HospitalHigashi Oi 6-3-22ShinagawaJapan
  6. 6.Department of HepatologyBangabandhu Sheikh Mujib Medical UniversityShanbaghBangladesh

Personalised recommendations