The rate of cirrhosis is rising in the general population, more so in young adults and women

The incidence and prevalence of cirrhosis has increased in Ontario over the past 20 years and in 2016 was present in almost one per cent of the general population, according to a new study by researchers at ICES.

Cirrhosis of the liver is a condition where scar tissue gradually replaces healthy liver cells. It is a progressive disease, developing slowly over many years. If it is allowed to progress, the buildup of scar tissue can eventually stop liver function where the only treatment is a liver transplant. Historically alcohol use and hepatitis C have been the most common causes of cirrhosis. However non-alcoholic fatty liver disease, estimated to be present in 30 per cent of Canadians, has become the most common cause of chronic liver disease in both children and adults in North America over the past two decades.

The study, published today in the journal Lancet Gastroenterology and Hepatology, is the first to look at the incidence of cirrhosis by age group. The researchers found the groups where the burden is increasing the most are in the generations born after the baby-boomers and in women.

Baby Boomers are born 1946-1964 (54-72 years old); Generation X are born 1965-1980 (38-53 years old); Millennials are born 1981-1996 (22-37 years old).

This study looked at more than 165,000 people in Ontario with cirrhosis from 1997 to 2016. The number of new cases of cirrhosis in 1997 was 6,318 (3,979 males/2,339 females) and jumped to 12,047 (7,061 males/4,986 females) new cases in 2016. The results showed that the risk of cirrhosis was 116 per cent higher if you were born in 1990 compared to being born in 1951. This difference was higher in women, where a woman born in 1990 was 160 per cent more likely to be diagnosed with cirrhosis than a woman born in 1951.

“Traditionally cirrhosis has been thought to be a disease of older men, but our data show that the face of cirrhosis is changing in Canada. Strategies to increase awareness of this disease in young adults and women are needed to try and reverse these trends for future generations. This is a public health issue as many of the causes of cirrhosis including viral hepatitis and alcohol consumption are treatable and cirrhosis can ultimately be prevented,” says Jennifer Flemming, lead author of the study, an adjunct scientist at ICES Queen’s and an assistant professor, Departments of Medicine and Public Health Sciences at Queen’s University, Kingston Health Sciences Centre.

This work was sponsored by a SEAMO New Clinician Scientist Award and an AASLD Foundation Clinical, Translational and Outcomes Research Award.

Author block: Flemming JA, Dewit Y, Mah JM, Saperia J, Groome PA, Booth CM.

The article “Incidence of cirrhosis in young birth cohorts in Canada from 1997-2016: a population-based study,” is published in the December 13, 2018 issue of Lancet Gastroenterology and Hepatology.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

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