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Cited by 1,129Alcohol Consumption and Health EffectsLiver Disease and TransplantationHealthcare Systems and Public Health

Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis

Open access
Mokdad, Ali A, Lopez, Alan D, Shahraz, Saied, Lozano, Rafael, Mokdad, Ali H, Stanaway, Jeff, Murray, Christopher JL, Naghavi, Mohsen·2014·BMC Medicine
DOI 10.1186/s12916-014-0145-yPMC PMC4169640
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Abstract

BACKGROUND: Liver cirrhosis is a major yet largely preventable and underappreciated cause of global health loss. Variations in cirrhosis mortality at the country level reflect differences in prevalence of risk factors such as alcohol use and hepatitis B and C infection. We estimated annual age-specific mortality from liver cirrhosis in 187 countries between 1980 and 2010. METHODS: We systematically collected vital registration and verbal autopsy data on liver cirrhosis mortality for the period 1980 to 2010. We corrected for misclassification of deaths, which included deaths attributed to improbable or nonfatal causes. We used ensemble models to estimate liver cirrhosis mortality with uncertainty by age, sex, country and year. We used out-of-sample predictive validity to select the optimal model. RESULTS: Global liver cirrhosis deaths increased from around 676,000 (95% uncertainty interval: 452,863 to 1,004,530) in 1980 to over 1 million (1,029,042; 670,216 to 1,554,530) in 2010 (about 2% of the global total). Over the same period, the age-standardized cirrhosis mortality rate decreased by 22%. This was largely driven by decreasing cirrhosis mortality rates in China, the US and countries in Western Europe. In 2010, Egypt, followed by Moldova, had the highest age-standardized cirrhosis mortality rates, 72.7 and 71.2 deaths per 100,000, respectively, while Iceland had the lowest. In Egypt, almost one-fifth (18.1%) of all deaths in males 45- to 54-years old were due to liver cirrhosis. Liver cirrhosis mortality in Mexico is the highest in Latin America. In France and Italy, liver cirrhosis mortality fell by 50% to 60%; conversely, in the United Kingdom, mortality increased by about one-third. Mortality from liver cirrhosis was also comparatively high in Central Asia countries, particularly Mongolia, Uzbekistan and Kyrgyzstan, and in parts of sub-Saharan Africa, notably Gabon. CONCLUSIONS: Liver cirrhosis is a significant cause of global health burden, with more than one million deaths in 2010. Our study identifies areas with high and/or rapidly increasing mortality where preventive measures to control and reduce liver cirrhosis risk factors should be urgently strengthened.

AI snapshot

Written from the paper’s full text.

TL;DR

Global liver cirrhosis deaths rose from 676,079 (95% UI 452,863–1,004,530) in 1980 to 1,029,042 (670,216–1,554,530) in 2010, while the age-standardized mortality rate fell 21.6%. The burden was highly heterogeneous, with Egypt and Moldova highest in 2010 and increases in Eastern Europe, Central Asia, and South Asia offsetting declines in East Asia and Western Europe.

Key findings

  • Global liver cirrhosis deaths increased from 676,079 (95% UI 452,863–1,004,530) in 1980 to 1,029,042 (670,216–1,554,530) in 2010, about 1.95% of global deaths; the age-standardized mortality rate decreased from 20.0 to 15.8 per 100,000, a 21.6% reduction.
  • In 2010, Egypt had the highest age-standardized cirrhosis mortality rate (72.7 per 100,000), followed by Moldova (71.2 per 100,000); Iceland had the lowest. In Egypt, 18.1% of deaths in males aged 45–54 years were due to liver cirrhosis.
  • Regional trends diverged: age-standardized mortality fell in East Asia (−61.3%), high-income Asia Pacific (−51.5%), and Western Europe (−42.9%), but rose in Eastern Europe (+58.5%), Central Asia (+28.4%), and South Asia (+12.8%).
  • Attributable fractions varied: in Western Europe about one-third of cirrhosis cases were attributable to heavy alcohol intake; in Central Asia more than half were attributed to hepatitis B and C (57% in 1990 and 54% in 2010); in sub-Saharan Africa about 30% of cases were related to neither hepatitis infection nor alcohol intake.

Methods

  • Systematic analysis of vital registration data (2,667 country-years) and 80 site-years of verbal autopsy for 187 countries, 1980–2010; deaths were corrected for misclassification and garbage codes, and hepatocellular carcinoma was excluded.
  • Cause of death ensemble modeling (CODEm) was used with covariates including population-level alcohol consumption, health system access, chronic hepatitis B and C prevalence, schistosomiasis, diabetes, BMI, education, and income; models were selected by out-of-sample RMSE and temporal trend tests and rescaled to the overall mortality envelope.
  • Ancillary analyses decomposed changes in deaths between 1990 and 2010 into population growth, aging, and rate changes, and estimated population attributable fractions using meta-regression in DisMod 3 from 31, 55, 74, and 26 studies on alcoholism, hepatitis B, hepatitis C, and other risks, respectively.

Limitations

  • The paper states that incomplete cause-of-death data and reliance on verbal autopsy, particularly in sub-Saharan Africa, greatly increase uncertainty; diagnostic misclassification occurs even with medically certified deaths, and redistribution algorithms for garbage codes remain uncertain.
  • The paper states that a broad case definition for liver cirrhosis may have inflated mortality estimates, while excluding hepatocellular carcinoma could underestimate true liver cirrhosis mortality.
  • Evident from the text: verbal autopsy methods were heterogeneous and not corrected for variability; no data were available from Central Sub-Saharan Africa, and verbal autopsy comprised most information for Eastern and Western Sub-Saharan Africa; physician-certified verbal autopsy accurately assigned liver cirrhosis in only 46% of cases in the cited PHMRC study.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12916-014-0145-y

Cites

96 of 96 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 128 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The global age-standardized liver cirrhosis mortality rate decreased by about 22% between 1980 and 2010, from 20.0 to 15.8 deaths per 100,000 person-years.

    “Over the same period, the age-standardized cirrhosis mortality rate decreased by 22%.”
    • Also stated in: § Results · plain
      “In terms of age-standardized mortality ratesa, liver cirrhosis decreased globally from 20.0 (95% uncertainty interval; 13.5 to 29.4) deaths per 100,000 person-years in 1980 to 15.8 (10.2 to 23.6) deaths per 100,000 person-years in 2010, a 21.6% reduction (Table 4).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The verbal autopsy data, despite heterogeneity in methods, are sufficiently comparable to be combined with vital registration data for estimating liver cirrhosis mortality.
    • Rests on an assumption: The 187 countries included in the analysis cover 99.7% of the global population.
  • Findingown data

    In France and Italy, liver cirrhosis mortality fell by 50% to 60% over the study period.

    “In France and Italy, liver cirrhosis mortality fell by 50% to 60%; conversely, in the United Kingdom, mortality increased by about one-third.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The verbal autopsy data, despite heterogeneity in methods, are sufficiently comparable to be combined with vital registration data for estimating liver cirrhosis mortality.
  • Findingown data

    Of 98,445 age- and sex-specific observations on cirrhosis deaths, 1,807 (1.8%) were identified as outliers.

    “Of 98,445 age- and sex-specific observations on cirrhosis deaths, 1,807 (or 1.8%) were identified as outliers based on the following criteria: implausible cause fractions, major inconsistencies with other sources within the same country, or pronounced deviations in mortality rates from comparator countries.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the United Kingdom, liver cirrhosis mortality increased by about one-third over the study period.

    “In France and Italy, liver cirrhosis mortality fell by 50% to 60%; conversely, in the United Kingdom, mortality increased by about one-third.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The verbal autopsy data, despite heterogeneity in methods, are sufficiently comparable to be combined with vital registration data for estimating liver cirrhosis mortality.
  • Findingnone given

    Liver cirrhosis mortality in Mexico is the highest in Latin America.

    “Liver cirrhosis mortality in Mexico is the highest in Latin America.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The verbal autopsy data, despite heterogeneity in methods, are sufficiently comparable to be combined with vital registration data for estimating liver cirrhosis mortality.
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 22
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingown data

    Mortality from liver cirrhosis was comparatively high in Central Asian countries, particularly Mongolia, Uzbekistan and Kyrgyzstan, and in parts of sub-Saharan Africa, notably Gabon.

    “Mortality from liver cirrhosis was also comparatively high in Central Asia countries, particularly Mongolia, Uzbekistan and Kyrgyzstan, and in parts of sub-Saharan Africa, notably Gabon.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The verbal autopsy data, despite heterogeneity in methods, are sufficiently comparable to be combined with vital registration data for estimating liver cirrhosis mortality.

  • May combine two claims.

    Findingown data

    In 2010, Egypt had the highest age-standardized liver cirrhosis mortality rate (72.7 per 100,000), followed by Moldova (71.2 per 100,000), while Iceland had the lowest.

    “In 2010, Egypt, followed by Moldova, had the highest age-standardized cirrhosis mortality rates, 72.7 and 71.2 deaths per 100,000, respectively, while Iceland had the lowest.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The verbal autopsy data, despite heterogeneity in methods, are sufficiently comparable to be combined with vital registration data for estimating liver cirrhosis mortality.

  • May combine two claims.

    Findingown data

    Liver cirrhosis deaths increased by 26% after redistribution of deaths assigned garbage codes; 40% of those were ill-defined gastrointestinal signs and symptoms.

    “Liver cirrhosis deaths increased by 26% after redistribution of deaths assigned garbage codes; 40% of those were ill-defined GI signs and symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    In Russia, the cirrhosis mortality rate increased drastically after 1990 but has declined in the last five years.

    “In Russia, the cirrhosis mortality rate increased drastically after 1990 but has declined in the last five years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Similar increases in mortality occurred in Pakistan and India between 1990 and 2000.

    “Similar increases in mortality also occurred in Pakistan and India between 1990 and 2000”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The global decrease in age-standardized liver cirrhosis mortality was offset by increases in South Asia (12.8% increase), Central Asia (28.4% increase) and Eastern Europe (58.5% increase).

    “This trend was offset by an increase in the age-standardized liver cirrhosis mortality rate in South Asia (18.8 to 21.3 deaths per 100,000; a 12.8% increase), Central Asia (26.3 to 33.7 deaths per 100,000; a 28.4% increase) and Eastern Europe (12.6 to 20.0 deaths per 100,000; a 58.5% increase) (Table 4).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The verbal autopsy data, despite heterogeneity in methods, are sufficiently comparable to be combined with vital registration data for estimating liver cirrhosis mortality.
    • Rests on an assumption: The 187 countries included in the analysis cover 99.7% of the global population.

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Mortality rates fell in Chile, Mexico and Argentina.

    “but fell in Chile, Mexico and Argentina.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    On average, there were twice as many liver cirrhosis male deaths as female deaths.

    “On average, there were twice as many liver cirrhosis male deaths as female deaths.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The verbal autopsy data, despite heterogeneity in methods, are sufficiently comparable to be combined with vital registration data for estimating liver cirrhosis mortality.
    • Rests on an assumption: The 187 countries included in the analysis cover 99.7% of the global population.

  • May combine two claims.

    Findingown data

    Moldova has high cirrhosis mortality rates among females, similar to males, with a male-to-female ratio of 1.15.

    “Moldova is unusual compared to its neighbors due to its high cirrhosis mortality rates among females, which were similar to males (male-to-female ratio of 1.15)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There were no data available from Central Sub-Saharan Africa, and verbal autopsy comprised the majority of information accrued for Eastern and Western Sub-Saharan Africa.

    “There were no data available from Central Sub-Saharan Africa and verbal autopsy comprised the majority of information accrued for Eastern and Western Sub-Saharan Africa.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Mortality rates increased in Costa Rica, Guatemala, Honduras and Paraguay.

    “Mortality rates increased in Costa Rica, Guatemala, Honduras and Paraguay”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In Southeast Asia, cirrhosis mortality increased in Indonesia, Sri Lanka and the Philippines.

    “increasing in Indonesia, Sri Lanka and the Philippines”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    In the UK, Ireland, and Finland, cirrhosis mortality rates have continued to increase since the late 1980s.

    “with the exception of the UK, Ireland, and Finland, where cirrhosis mortality rates have continued to increase since the late 1980s.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    In 2010, liver cirrhosis ranked as the 23rd cause of disease burden worldwide, causing 31 million or 1.2% of global DALYs.

    “In 2010, liver cirrhosis ranked as the 23rd cause of disease burden worldwide causing 31 million or 1.2% of global DALYs”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, et al: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012, 380: 2197-2223. 10.1016/S0140-6736(12)61689-4. source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Liver cirrhosis deaths worldwide have increased steadily over the past 30 years, exceeding one million in 2010.

    “Liver cirrhosis deaths worldwide have increased steadily over the past 30 years, exceeding one million in 2010”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In 2010, liver cirrhosis deaths were approximately 2% of all deaths in that year.

    “or approximately 2% of all deaths in that year.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In Mongolia, at least 20% of patients with liver cirrhosis had dual hepatitis infection.

    “In neighboring Mongolia, 99% of patients with liver cirrhosis had viral hepatitis, and at least 20% had dual hepatitis infection [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Dondog B, Lise M, Dondov O, Baldandorj B, Franceschi S: Hepatitis B and C virus infections in hepatocellular carcinoma and cirrhosis in Mongolia. Eur J Cancer Prev. 2011, 20: 33-39. 10.1097/CEJ.0b013e32833f0c8e. source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Liver cirrhosis mortality in China has decreased, in contrast to India.

    “This contrasts with reductions in liver cirrhosis mortality in China.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    More recently, mortality has stabilized or even declined modestly in Eastern Europe, although liver cirrhosis death rates remain alarmingly high, specifically in Moldova and Hungary.

    “More recently, mortality has stabilized or even declined modestly in the region, although liver cirrhosis death rates remain alarmingly high, specifically in Moldova and Hungary.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    In Uganda and Gabon, alcohol was a more predominant factor in comparison to other neighboring countries.

    “Notably, in Uganda and Gabon, alcohol was a more predominant factor in comparison to other neighboring countries.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The general trend of liver cirrhosis mortality has stabilized in Sub-Saharan Africa recently.

    “The general trend of liver cirrhosis mortality has stabilized in Sub-Saharan Africa recently”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Case fatality rates in Latin America have either remained unchanged or may have increased between 1990 and 2010.

    “case fatality rates in Latin America have either remained unchanged or may have increased between 1990 and 2010 (estimated from analysis of hospital data) [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, et al: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012, 380: 2095-2128. 10.1016/S0140-6736(12)61728-0. source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    The temporal trend of liver diseases in Sub-Saharan Africa mirrored those of liver cirrhosis, with increasing number of deaths and down trending mortality rates.

    “The temporal trend of liver diseases in this region mirrored those of liver cirrhosis discussed earlier, increasing number of deaths and down trending mortality rates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Mortality from liver cirrhosis accounts for a growing and substantial disease burden worldwide each year, causing more than one million deaths in 2010.

    “We estimate that mortality from liver cirrhosis accounts for a growing and substantial disease burden worldwide each year, causing more than one million deaths in 2010.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Predicted deaths for each cause were rescaled to fit the overall mortality envelope for each age-sex-year-country group.

    “The final step in estimating causes of death was to rescale the predicted deaths for each cause in the GBD study to fit the overall mortality envelope for each age-sex-year-country group, obtained separately from demographic analyses [12].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Wang H, Dwyer-Lindgren L, Lofgren KT, Rajaratnam JK, Marcus JR, Levin-Rector A, Levitz CE, Lopez AD, Murray CJL: Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012, 380: 2071-2094. 10.1016/S0140-6736(12)61719-X. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    According to the Global Burden of Disease 2010 study, liver cirrhosis caused one million deaths, or 2% of all deaths worldwide, in 2010.

    “According to the Global Burden of Disease 2010 study, liver cirrhosis caused 31 million Disability Adjusted Life Years (DALYs), or 1.2% of global DALYs, in 2010, and one million deaths, or 2% of all deaths worldwide in that year [1,2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, et al: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012, 380: 2197-2223. 10.1016/S0140-6736(12)61689-4. source

      Not checked in the free run.

    • cites [2] Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, et al: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012, 380: 2095-2128. 10.1016/S0140-6736(12)61728-0. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Predictive validity of the ensemble and all component individual models was assessed using two out-of-sample performance metrics: root mean squared error of the logarithm of the death rate and a trend test.

    “We assessed predictive validity of the ensemble and all component individual models using two out-of-sample performance metrics.”
    • Also stated in: § Model development · plain
      “First, we evaluated the predictive ability of every model using the root mean squared error (RMSE) of the logarithm of the death rate. Second, we assessed the percentage of time the model correctly predicted the temporal trend via a trend test.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The best performing component model or ensemble was selected based on the sum of ranks in the two out-of-sample performance metrics.

    “Based on the sum of ranks in these two metrics, the best performing component model or ensemble was selected.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    According to the Global Burden of Disease 2010 study, liver cirrhosis caused 31 million Disability Adjusted Life Years (DALYs), or 1.2% of global DALYs, in 2010.

    “According to the Global Burden of Disease 2010 study, liver cirrhosis caused 31 million Disability Adjusted Life Years (DALYs), or 1.2% of global DALYs, in 2010, and one million deaths, or 2% of all deaths worldwide in that year [1,2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, et al: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012, 380: 2197-2223. 10.1016/S0140-6736(12)61689-4. source

      Not checked in the free run.

    • cites [2] Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, et al: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012, 380: 2095-2128. 10.1016/S0140-6736(12)61728-0. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    All possible combinations of covariates were modeled and retained only if the sign on coefficients was in the expected direction based on the literature and coefficients were statistically significant (P-value <0.05).

    “We modeled all possible combinations of covariates and retained those combinations where the sign on the coefficients was in the expected direction, based on the literature, and if the coefficients were statistically significant (P-value <0.05).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Egypt's high prevalence of chronic hepatitis C is reflected in very high liver cirrhosis mortality rates, particularly in males.

    “This is reflected in the very high liver cirrhosis mortality rates, particularly in males.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The decline in schistosomiasis due to praziquantel and strict control programs may have played a role in declining cirrhosis mortality in China.

    “The decline in schistosomiasis secondary to introduction of praziquantel and the implementation of strict control programs may have also played a role in declining cirrhosis mortality in China [59,60].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [59] Minggang C, Zheng F: Schistosomiasis control in China. Parasitol Int. 1999, 48: 11-19. 10.1016/S1383-5769(99)00004-5. source

      Not checked in the free run.

    • cites [60] Utzinger J, Zhou XN, Chen MG, Bergquist R: Conquering schistosomiasis in China: the long march. Acta Trop. 2005, 96: 69-96. 10.1016/j.actatropica.2005.08.004. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Alcohol related liver cirrhosis underlies the significant declines in cirrhosis burden in Europe over the past two decades, but also the substantial increases in Latin America.

    “Alcohol related liver cirrhosis underlies the significant declines in cirrhosis burden in Europe over the past two decades, but also the substantial increases in Latin America.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Alcohol consumption, prevalence of hepatitis B and C, and diabetes prevalence have increased in India since 1980.

    “as has alcohol consumption, prevalence of hepatitis B and C and diabetes (a major risk factor for nonalcoholic fatty liver disease (NAFLD)) [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Tanaka H, Tsukuma H, Yamano H, Oshima A, Shibata H: Prospective study on the risk of hepatocellular carcinoma among hepatitis C virus-positive blood donors focusing on demographic factors, alanine aminotransferase level at donation and interaction with hepatitis B virus. Int J Cancer. 2004, 112: 1075-1080. 10.1002/ijc.20507. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Liver cirrhosis is a particular health priority in Central Asia (ranked 9th among leading causes of disease burden in 2010), Central Europe (rank 10), Eastern Europe (rank 11) and Central Latin America (rank 12).

    “Regionally, our findings suggest that liver cirrhosis is a particular health priority in Central Asia (ranked 9th among the leading causes of disease burden in 2010), Central Europe (rank 10), Eastern Europe (rank 11) and Central Latin America (rank 12).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2005, a national hepatitis B control plan was introduced in China with the goal of reducing HBsAg seroprevalence to less than 1% in five-year-old children by 2010.

    “In 2005, a national hepatitis B control plan was introduced with the goal of reducing HBsAg seroprevalence to less than 1% in five-year-old children by 2010 [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Rani M, Yang B, Nesbit R: Hepatitis B control by 2012 in the WHO Western Pacific Region: rationale and implications. Bull World Health Organ. 2009, 87: 707-713. 10.2471/BLT.08.059220. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the UK, the increase in cirrhosis mortality prompted a national call by the Chief Medical Officer for prioritizing prevention, identification and treatment of liver disease.

    “In contrast, the alarming increase in cirrhosis mortality in the UK recently prompted a national call by the Chief Medical Officer for prioritizing the prevention, identification and treatment of liver disease in the UK [61].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Davies S: Annual Report of the Chief Medical Officer, Volume One, 2011, On the State of the Public’s Health. 2012, Department of Health, London

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    By 2007, 65% of African member states had included extended hepatitis B vaccination in their immunization schedule.

    “By 2007, 65% of African member states had included extended hepatitis B vaccination in their immunization schedule [73,74].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [73] Kew MC: Progress towards the comprehensive control of hepatitis B in Africa: a view from South Africa. Gut. 1996, 38: S31-S36. 10.1136/gut.38.Suppl_2.S31. source

      Not checked in the free run.

    • cites [74] Wiersma ST: Hepatitis B Immunization: Where do we go from Here?- 2009, [ www.who.int/immunization/newsroom/180209_S_Wiersma.pdf ]

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The UK increase in liver cirrhosis mortality was likely driven by an increase in alcohol consumption and a shift to a higher proportion of alcohol intake in the form of spirits and binge drinking outside of meals.

    “and was likely driven by an increase in alcohol consumption and a shift to a higher proportion of alcohol intake in the form of spirits and binge drinking outside of meals [25,63,64].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [25] Food and Agriculture Organization of the United Nations: National Food Balance Sheets. , [], [ http://faostat.fao.org/site/354/default.aspx ]

      Not checked in the free run.

    • cites [63] Global Status Report on Alcohol and Health. 2012, World Health Organization Press, Switzerland

      Not checked in the free run.

    • cites [64] Pincock S: Binge drinking on rise in UK and elsewhere. Government report shows increases in alcohol consumption, cirrhosis, and premature deaths. Lancet. 2003, 362: 1126-1127. 10.1016/S0140-6736(03)14502-3. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Part of the decline in cirrhosis mortality in China may be an artifact of incorrect assignment of liver cirrhosis as an underlying cause of death for deaths actually due to schistosomiasis.

    “Part of the decline in China may also be an artifact of the incorrect assignment of liver cirrhosis as an underlying cause of death for deaths actually due to schistosomiasis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The decline in liver cirrhosis mortality in Western Europe, particularly Spain, France and Italy, is due to a steady decrease in alcohol consumption, accompanied by improvement in wine quality and restrictions on home-brewed alcoholic beverage making.

    “The decline in liver cirrhosis mortality in Western Europe, particularly in Spain, France and Italy, is undoubtedly due to a steady decrease in alcohol consumption, accompanied by an improvement in the quality of wine and restrictions on home-brewed alcoholic beverage making [5,36–39].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [5] Zatoński WA, Sulkowska U, Mańczuk M, Rehm J, Boffetta P, Lowenfels AB, La Vecchia C: Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe. Eur Addict Res. 2010, 16: 193-201. 10.1159/000317248. source

      Not checked in the free run.

    • cites [36] D’ Houtaud A, Adriaanse H, Field MG: Alcohol consumption in France: production, consumption, morbidity and mortality, prevention and education in the last three decades. Adv Alcohol Subst Abuse. 1989, 8: 19-44. 10.1300/J251v08n01_02. source

      Not checked in the free run.

    • cites [37] Gual A, Colom J: Why has alcohol consumption declined in countries of southern Europe?. Addiction. 1997, 92: S21-S31. 10.1111/j.1360-0443.1997.tb03392.x. source

      Not checked in the free run.

    • cites [38] Ramstedt M: Per capita alcohol consumption and liver cirrhosis mortality in 14 European countries. Addiction. 2001, 96: S19-S33. 10.1080/09652140020021152. source

      Not checked in the free run.

    • cites [39] La Vecchia C: Alcohol in the Mediterranean diet: benefits and risks. Int J Vitam Nutr Res. 2001, 71: 210-213. 10.1024/0300-9831.71.3.210. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Rising hepatitis C prevalence and a growing obesity epidemic in the UK have likely also played a role in increasing the liver cirrhosis burden over the past two decades.

    “Rising hepatitis C prevalence and a growing obesity epidemic in the UK have likely also played a role in increasing the liver cirrhosis burden over the past two decades [34,68,69].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] Tanaka H, Tsukuma H, Yamano H, Oshima A, Shibata H: Prospective study on the risk of hepatocellular carcinoma among hepatitis C virus-positive blood donors focusing on demographic factors, alanine aminotransferase level at donation and interaction with hepatitis B virus. Int J Cancer. 2004, 112: 1075-1080. 10.1002/ijc.20507. source

      Not checked in the free run.

    • cites [68] McAvoy NC, Hayes PC: The cirrhosis epidemic in the UK: evaluating the causes in a European context. Expert Rev Gastroenterol Hepatol. 2007, 1: 41-45. 10.1586/17474124.1.1.41. source

      Not checked in the free run.

    • cites [69] Williams R: Global challenges in liver disease. Hepatology. 2006, 44: 521-526. 10.1002/hep.21347. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    The study's redistribution algorithms improved comparability across ICD revisions and reduced the impact of garbage codes.

    “while we believe that our redistribution algorithms have improved comparability across ICD revisions and reduced the impact of garbage codes”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Preventive measures such as screening transfused blood for viral hepatitis, employing appropriate medical hygiene in health facilities, introducing hepatitis B vaccination programs, imposing alcohol trade restrictions and raising taxes on alcohol, and implementing health promotion and education programs to reduce alcohol consumption and harmful alcohol use are relatively inexpensive and cost-ef

    “By contrast, preventive measures such as screening transfused blood for viral hepatitis, employing appropriate medical hygiene in health facilities, introducing hepatitis B vaccination programs, imposing alcohol trade restrictions and raising taxes on alcohol, implementing health promotion and education programs to reduce alcohol consumption and harmful alcohol use are relatively inexpensive and”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [3] Bosetti C, Levi F, Lucchini F, Zatonski WA, Negri E, La Vecchia C: Worldwide mortality from cirrhosis: an update to 2002. J Hepatol. 2007, 46: 827-839. 10.1016/j.jhep.2007.01.025. source

      Not checked in the free run.

    • cites [4] Corrao G, Ferrari P, Zambon A, Torchio P, Aricò S, Decarli A: Trends of liver cirrhosis mortality in Europe, 1970-1989: age-period-cohort analysis and changing alcohol consumption. Int J Epidemiol. 1997, 26: 100-109. 10.1093/ije/26.1.100. source

      Not checked in the free run.

    • cites [5] Zatoński WA, Sulkowska U, Mańczuk M, Rehm J, Boffetta P, Lowenfels AB, La Vecchia C: Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe. Eur Addict Res. 2010, 16: 193-201. 10.1159/000317248. source

      Not checked in the free run.

    • cites [43] Shepard CW, Finelli L, Alter MJ: Global epidemiology of hepatitis C virus infection. Lancet Infect Dis. 2005, 5: 558-567. 10.1016/S1473-3099(05)70216-4. source

      Not checked in the free run.

    • cites [93] Huang LM, Lu CY, Chen DS: Hepatitis B virus infection, its sequelae, and prevention by vaccination. Curr Opin Immunol. 2011, 23: 237-243. 10.1016/j.coi.2010.12.013. source

      Not checked in the free run.

    • cites [94] Schillie SF, Murphy TV: Seroprotection after recombinant hepatitis B vaccination among newborn infants: a review. Vaccine. 2013, 31: 2506-2516. 10.1016/j.vaccine.2012.12.012. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    A broad definition for liver cirrhosis was used, which may have inflated the study's mortality estimates.

    “Fourth, a broad definition for liver cirrhosis was used for reasons listed elsewhere in this manuscript, which may have inflated our mortality estimates.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Excluding hepatocellular carcinoma from the definition could underestimate true liver cirrhosis mortality.

    “Fifth, we have excluded hepatocellular carcinoma from our definition, as discussed under the section ‘case definition of liver cirrhosis’, which could underestimate true liver cirrhosis mortality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    There is still uncertainty surrounding the redistribution algorithms employed.

    “there is still uncertainty surrounding the redistribution algorithms employed [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Naghavi M, Makela S, Foreman K, O’Brien J, Pourmalek F, Lozano R: Algorithms for enhancing public health utility of national causes-of-death data. Popul Health Metr. 2010, 8: 9-10.1186/1478-7954-8-9. source

      Not checked in the free run.

47 of 47

  • The paper relies on this without support.

    The verbal autopsy data, despite heterogeneity in methods, are sufficiently comparable to be combined with vital registration data for estimating liver cirrhosis mortality.

    “Admittedly, verbal autopsy data are highly heterogeneous owning to multiple questionnaire versions, different recall periods, variable age and sex groups, distinct cultures and variable methods for assigning cause of deaths. We did not correct for variability in verbal autopsy methods”

  • The paper relies on this without support.

    The 187 countries included in the analysis cover 99.7% of the global population.

    “Our aim was to estimate annual liver cirrhosis mortality levels, patterns, and temporal trends between 1980 and 2010 for 187 countries covering 99.7% of the global population.”

  • The paper relies on this without support.

    Treatment of liver cirrhosis is expensive and largely inaccessible in most parts of the world.

    “Treatment of this disease is expensive and is largely inaccessible in most parts of the world.”

  • The paper relies on this without support.

    Hepatitis C is a major driver of liver cirrhosis in Africa.

    “In comparison, hepatitis C, the other major driver of liver cirrhosis in Africa, is more difficult to control.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The more accelerated dose-response curve for mortality is due to the fact that liver damage can have different aetiologies, but if the liver is damaged continuation of alcohol use, even at relatively low quantities, can lead to death.

    “The more accelerated dose–response curve for mortality is due to the fact that liver damage can have different aetiologies (most prominently, hepatitis B or C 281), but if the liver is damaged continuation of alcohol use, even at relatively low quantities, can lead to death.”

    From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [281]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two totals given for 2010 sub-Saharan African cirrhosis deaths

    Minor

    The Results text reports 102,609 cirrhosis deaths in sub-Saharan Africa in 2010, but Table 5 reports 102,887.

  • Chile and Mexico's 1980 rates are reversed

    Minor

    The text assigns 53.4 per 100,000 to Chile and 45.9 to Mexico. Table 4 assigns 53.4 to Mexico and 45.9 to Chile.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Recommendations from the Special Advisory Group of Experts. Part I. Wkly Epidemiol Rec. 1996, 71: 261-266.
  2. Murray CJL, Lopez AD: The Global Burden of Disease, GBD 1990 Study. 1996, Harvard University Press, Cambridge, MA
  3. Davies S: Annual Report of the Chief Medical Officer, Volume One, 2011, On the State of the Public’s Health. 2012, Department of Health, London
  4. Global Status Report on Alcohol and Health. 2012, World Health Organization Press, Switzerland

Cited by

Sorted by citations

Related

Authors
Mokdad, A. A., Lopez, A. D., Shahraz, S., Lozano, R., Mokdad, A. H., Stanaway, J., Murray, C. J., & Naghavi, M.
Affiliations
  • University of Washington (US)
  • Brandeis University (US)
Corresponding author
  • Mokdad, Ali A
  • Mokdad, Ali H
ORCID
Venue
BMC Medicine
Publisher
Springer Science and Business Media LLC
Published
2014-09-18
Volume
12
Issue
1
Pages
145-145
ISSN
1741-7015 (ISSN-L)
DOI
10.1186/s12916-014-0145-y
PMC
PMC4169640
OpenAlex
W2124273275
Semantic Scholar
4daa5734b693c449f4877e2834ec6fd4d26afe3c
Cited by
1,129
References
96
Citations by year
2026: 23 · 2025: 56 · 2024: 95 · 2023: 138 · 2022: 124 · 2021: 138 · 2020: 139 · 2019: 116 · 2018: 119 · 2017: 98 · 2016: 55 · 2015: 25 · 2014: 2
FWCI
44.58
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Funders
Bill and Melinda Gates Foundation
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
Keywords
liver cirrhosis, cirrhosis mortality, global health burden, age-standardized mortality rates, mortality trends, verbal autopsy, civil registration, alcohol consumption, hepatitis B, hepatitis C, sub-Saharan Africa, Central Asia, Egypt, Mexico, Latin America, Western Europe, China, United States, Mongolia, Uzbekistan, Kyrgyzstan
MeSH terms
Aged, 80 and over, China, Europe, Female, France, United Kingdom, Humans, Italy, Liver Cirrhosis, Male, Mexico, Middle Aged, Risk Factors, Prevalence, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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