Mortality in People With Cirrhosis vs the General Population
Mortality in People With Cirrhosis vs the General Population
Background: Mortality due to cirrhosis has tripled over the last 30 years in the UK. However, we lack adequate, contemporary, population-based estimates of the excess mortality patients who are at risk compared with the general population.
Aim: To determine the overall survival in patients with cirrhosis compared with the general population taking into account the effects of severity and aetiology of disease and comorbidity.
Methods: In a cohort study, we identified 4537 people with cirrhosis and a control cohort of 44 403 patients, matched by age, sex and general practice from the UK General Practice Research Database between June 1987 and April 2002.
Results: Patients with compensated cirrhosis had a nearly five-fold [hazard ratio (HR) 4.7, 95% confidence interval (CI) 4.4–5.0] increased risk of death, while those with decompensated cirrhosis had a near 10-fold (HR 9.7, 95% CI 8.9–10.6) increased risk compared with the general population. Alcoholic cirrhosis conferred a worse prognosis than non-alcohol-related cirrhosis both in the first year following diagnosis and subsequently.
Conclusion: Having a diagnosis of cirrhosis confers a substantial increased mortality risk compared with the general population, even for those with compensated disease, with 5-year survival between that seen for breast and colorectal cancer.
Mortality from cirrhosis in the UK has tripled over the last three decades, and recent estimates of the incidence of cirrhosis suggest that this is also increasing raising the spectre of escalating morbidity and mortality in the future. There are several studies that report the number of people who die with a recording of cirrhosis on their death certificate and the trends in such data, but there is little information about the mortality experience of patients with cirrhosis.
Few contemporary studies have been able to take a truly population-based approach (i.e. including those patients who are not admitted to hospital) to determine the mortality experience with the general population taking into account both comorbid conditions and the aetiology and severity of the liver disease.
Perhaps, the most commonly referenced figures in the literature looking at the mortality experience of patients with cirrhosis are those based on 1155 consecutive patients admitted to a single hospital in Sicily during the 1970s and 1980s. More recently, two studies have approached the issue of survival in cirrhosis using large hospital-based databases. Thus, most of our knowledge on the mortality experience of people with cirrhosis is from few highly selected populations that may not broadly represent the whole population of people with cirrhosis, i.e. including those who do not require admission to hospital with their disease.
Additionally, we do not have precise and contemporary estimates of the all-cause mortality at a population level of people with cirrhosis taking into account the compensated or decompensated state of the patient. Nor have we previously been able to make the necessary comparisons with the general population to understand the magnitude of the burden of this disease. Indeed, in a recent Health Technology Assessment systematic review it was claimed that existing data suggest that there is no excess mortality in those patients with compensated disease compared with the general population for the purposes of the cost-effectiveness analysis carried out. We have therefore taken the opportunity presented by prospectively recorded electronic primary care data from the UK to determine the overall survival in patients with cirrhosis compared with the general population while taking into account the effects of comorbidity and aetiology of disease.
Abstract and Introduction
Abstract
Background: Mortality due to cirrhosis has tripled over the last 30 years in the UK. However, we lack adequate, contemporary, population-based estimates of the excess mortality patients who are at risk compared with the general population.
Aim: To determine the overall survival in patients with cirrhosis compared with the general population taking into account the effects of severity and aetiology of disease and comorbidity.
Methods: In a cohort study, we identified 4537 people with cirrhosis and a control cohort of 44 403 patients, matched by age, sex and general practice from the UK General Practice Research Database between June 1987 and April 2002.
Results: Patients with compensated cirrhosis had a nearly five-fold [hazard ratio (HR) 4.7, 95% confidence interval (CI) 4.4–5.0] increased risk of death, while those with decompensated cirrhosis had a near 10-fold (HR 9.7, 95% CI 8.9–10.6) increased risk compared with the general population. Alcoholic cirrhosis conferred a worse prognosis than non-alcohol-related cirrhosis both in the first year following diagnosis and subsequently.
Conclusion: Having a diagnosis of cirrhosis confers a substantial increased mortality risk compared with the general population, even for those with compensated disease, with 5-year survival between that seen for breast and colorectal cancer.
Introduction
Mortality from cirrhosis in the UK has tripled over the last three decades, and recent estimates of the incidence of cirrhosis suggest that this is also increasing raising the spectre of escalating morbidity and mortality in the future. There are several studies that report the number of people who die with a recording of cirrhosis on their death certificate and the trends in such data, but there is little information about the mortality experience of patients with cirrhosis.
Few contemporary studies have been able to take a truly population-based approach (i.e. including those patients who are not admitted to hospital) to determine the mortality experience with the general population taking into account both comorbid conditions and the aetiology and severity of the liver disease.
Perhaps, the most commonly referenced figures in the literature looking at the mortality experience of patients with cirrhosis are those based on 1155 consecutive patients admitted to a single hospital in Sicily during the 1970s and 1980s. More recently, two studies have approached the issue of survival in cirrhosis using large hospital-based databases. Thus, most of our knowledge on the mortality experience of people with cirrhosis is from few highly selected populations that may not broadly represent the whole population of people with cirrhosis, i.e. including those who do not require admission to hospital with their disease.
Additionally, we do not have precise and contemporary estimates of the all-cause mortality at a population level of people with cirrhosis taking into account the compensated or decompensated state of the patient. Nor have we previously been able to make the necessary comparisons with the general population to understand the magnitude of the burden of this disease. Indeed, in a recent Health Technology Assessment systematic review it was claimed that existing data suggest that there is no excess mortality in those patients with compensated disease compared with the general population for the purposes of the cost-effectiveness analysis carried out. We have therefore taken the opportunity presented by prospectively recorded electronic primary care data from the UK to determine the overall survival in patients with cirrhosis compared with the general population while taking into account the effects of comorbidity and aetiology of disease.
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