Addressing Worldwide Disparities in Liver Cirrhosis Mortality

Discover the global disparities in liver cirrhosis mortality rates and the urgent need for equitable care. Learn about the key findings and recommendations.

Highlights:

Study reveals significantly higher mortality rates from cirrhosis in lower-income countries due to limited access to diagnostic and therapeutic resources
Cirrhosis patients in lower-income countries face a higher prevalence of gastrointestinal bleeding and hepatitis B flare or infection, reflecting a lack of outpatient care and personal financial resources
Public policy changes and prioritizing disease prevention can help address disparities, enhance clinical outcomes, and save lives affected by advanced liver disease

New findings are shedding light on the disparities in mortality rates from late-stage liver disease, also known as cirrhosis, on a global scale. A recent study published in Lancet Gastroenterology & Hepatology has revealed that the risk of death for hospitalized cirrhosis patients is significantly higher in lower or lower-middle-income countries compared to high-income countries (). This disparity is primarily due to limited access to diagnostic and therapeutic resources in these countries.

Stark Reality of Liver Cirrhosis Mortality and the Urgency for Equitable Care

Chronic inflammation of the liver, often caused by obesity, excessive alcohol use, viral hepatitis, or a combination of factors, leads to liver disease. Over time, this inflammation can result in severe scarring, known as cirrhosis, which impairs liver function and can ultimately lead to liver failure. Liver disease is a leading cause of death worldwide, currently accounting for 2 million deaths annually, with projections indicating even higher mortality rates in the future.

To investigate the variations in death risk from cirrhosis across countries and understand the underlying factors contributing to these inequities, researchers, including Bajaj and Ashok K. Choudhury, M.D., a hepatologist and professor at the Institute for Liver and Biliary Sciences in India, collaborated with experts from around the globe. This collaborative research group, known as the Chronic Liver Disease Evolution And Registry for Events and Decompensation (CLEARED) Consortium, aimed to provide a comprehensive analysis of cirrhosis mortality from a global perspective.

Liver Cirrhosis - Causes, Symptoms, Diagnosis, Treatment & Prevention
Liver cirrhosis is a chronic liver disease that arises due to alcoholism, hepatitis, or other conditions. Liver failure patients are treated with transplantation.

‘New study uncovers shocking global disparities in cirrhosis mortality rates. Limited access to resources in lower-income countries contributes to higher risks. Urgent action is needed to address preventable conditions and ensure equitable care. #CirrhosisMortality #GlobalHealth’

The team collected and analyzed medical data from nearly 4,000 patients with cirrhosis, encompassing 90 medical centers in 25 countries across six continents. The data revealed that compared to patients treated in high-income countries, cirrhosis patients in lower-income countries faced a more than twofold increased risk of death in the hospital (8% vs. 22%) or within 30 days of discharge (14% vs. 30%).

"These results are very shocking and sobering. We did not anticipate such a wide disparity in cirrhosis mortality, but it shows that globally we are not on a level playing field when it comes to addressing advanced liver disease," commented Bajaj, the lead author of the study.

Overcoming Disparities in Liver Cirrhosis Care and Saving Lives

The study also shed light on the global differences in medical resources that contribute to the divergence in mortality rates. The data indicated that cirrhosis patients in lower-income countries had limited access to affordable diagnostics, medications, therapies, intensive care units (ICUs), and liver transplants during hospitalization. Additionally, these patients were more likely to be hospitalized at advanced stages of the disease and had a higher prevalence of preventable conditions such as gastrointestinal bleeding and hepatitis B flare or infection. These findings suggest a lack of outpatient care and personal financial resources for patients in lower-income countries.

Bajaj emphasized the importance of initiating patient care for cirrhosis before hospitalization is necessary, emphasizing the significance of recognition, access to care, and affordability of treatment in preventing avoidable hospitalizations.

Biliary Cirrhosis - Symptoms - Diagnosis - Complications - Treatment - Video
Biliary cirrhosis occurs due to obstruction to the flow of bile through bile ducts either within the liver or outside the liver.

Addressing this issue requires public policy changes implemented by local governments to promote preventive healthcare and increase access to essential resources. Even incremental improvements in these areas can significantly enhance clinical outcomes for cirrhosis patients.

"While the current situation may seem daunting, given the rising prevalence of chronic health issues like diabetes, obesity, and alcohol use disorder that contribute to liver disease globally, there are steps we can take to change the course and save more lives. Raising awareness of these issues and prioritizing disease prevention are the foundation for meaningful change," added Bajaj.

Fibroscan for Fatty Liver Cirrhosis and Fibrosis - Causes, Symptoms, Treatment
Recently, Fibroscan has incorporated the noninvasive Controlled Attenuation Parameter technique to estimate the degree of fatty infiltration in the liver.

Reference:

Global disparities in mortality and liver transplantation in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium - (https://pubmed.ncbi.nlm.nih.gov/37230109/)

Source-Medindia