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Epidemiology of Chronic Liver Disease in the United States

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Clinical Epidemiology of Chronic Liver Diseases

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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Correspondence to Andre N. Sofair .

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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):524–30.

Repeated cross-sectional surveys using NHANES to determine trends in the etiologies of chronic liver disease in the United States from 1988 to 2008.

• Prevalence of HCV has remained stable

• Prevalence of alcoholic liver disease has remained stable

• NAFLD has increase in prevalence from 5.5% in 1988–1994 to 11.0% in 2005–2008

• NHANES only captures non-institutionalized adults

• Immigrants, 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):2727–36

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

• Yearly incidence rate was 63.9/100,000 population between 1999 and 2001

• 42% 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

• 18% presented with cirrhosis

• Referral population

• 49% of eligible patients participated

• Three geographical areas in the United States were included

• Patients 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, 1988–1994. American Journal of Epidemiology. 2013;178(1):38–45.

Cross-sectional study using ultrasonography in the diagnosis of nonalcoholic fatty liver

• Prevalence of NAFLD was 19.0%

• 28.8 million adults estimated to have NAFLD nationwide

• More common in Mexican-Americans and in men compared with women

• Independently associated with diabetes, insulin resistance dyslipidemia, and with obesity

• Cross-sectional so could not define causality

• Unable to detect inflammation as used ultrasound alone

• Data are 20 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, 1982–1998: implications for vaccination programs. J Infect Dis. 2002;185(6):713–9.

Cross-sectional analysis of patient data from county-based health department reports of HBV infection in four U.S. counties from 1982 to 1998.

• Incidence of HBV decreased from 13.5/100,000 persons initially in 1982 to 3.3/100,000 by 1998

• Individuals aged 10–19 years old had the greatest decline in incidence (72.5%)

• Data are 20 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), 1988–2012. Hepatology. 2016;63(2):388–97

Repeated cross-sectional surveys of NHANES data assessing the prevalence of hepatitis B in the United States from 1988 through 2012.

• Overall prevalence of chronic HBV infection was found to be fairly constant over the last two decades at approximately 0.3%

• 3.1% 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

• In 6–19 year olds, prevalence of chronic HBV decreased from 0.24% in 1988–1994 to 0.05% in 1999–2006

• NHANES only captures non-institutionalized adults

• Immigrants, 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 1945–1965. MMWR Recommendations and reports: Morbidity and mortality weekly report Recommendations and reports. 2012;61(RR-4):1–32

Systematic Review. Guidelines based upon multiple population-based epidemiologic studies (mostly NHANES) on the prevalence of HCV by age corhort

• Individuals 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

• CDC recommends one-time HCV screening of all individuals in this birth cohort

• NHANES only captures non-institutionalized adults

• Immigrants, 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):293–300.

Repeated cross-sectional surveys using NHANES to determine trends in hepatitis C incidence and prevalence in the United States

• Chronic HCV infection affects approximately 1% of the U.S. population, or an estimated 2.7 million people

• Individuals who use IV drugs, or who received blood transfusions prior 1992 were more likely to be infected than the general population

• NHANES only captures non-institutionalized adults

• Immigrants, 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 the 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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