Women are suffering growing rates of liver cirrhosis, researchers in Canada’s largest province found, although causes and future burdens vary considerably among age groups.
The most important factors from a population standpoint are alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD), said Jennifer Flemming, MD, of Queen’s University in Kingston, Ontario, in a presentation at the virtual American Association for the Study of Liver Diseases annual meeting.
Rates of both show correlations with age but in the opposite directions, she reported from data compiled by Ontario’s ICES research institute.
NAFLD cirrhosis in women has been most prominent among those born before 1946 and the “baby boom” generation born from 1946 to 1964. In both groups, incidence rates more than doubled from 2000 to 2018, reaching about 140 per 100,000 population in the oldest cohort and about 100 per 100,000 among baby boomers.
Annual increases in NAFLD cirrhosis rates were highest for boomers at 8.6%, but next highest for so-called Generation X (1965-1980 birth years) at 7.4%, Flemming said.
Those two groups will see the greatest burden in the future, according to her group’s projections, with both approaching incidence rates of 200 per 100,000 by the year 2040.
For ALD cirrhosis in women, trajectories show marked declines in the pre-1946 birth group during 2000-2018, while plateauing among baby boomers. Among younger Ontarians, meanwhile, alcoholic cirrhosis rates have been soaring: up 9.4% annually for Gen-X and 12.8% among millennials (born 1980 onward).
Gen-X women should see liver cirrhosis rates stabilizing at about 17-19 per 100,000 by 2030, while rates in millennials will rise steadily to a similar level by 2040, Flemming said.
Currently, rates of cirrhosis from ALD in women range from about 5 to 20 per 100,000 in the four age groups.
Other contributors to women’s liver cirrhosis include viral hepatitis and other conditions such as autoimmune disease. These are becoming less significant sources of end-stage liver disease, thanks in large part to curative treatments for hepatitis C and effective vaccines against hepatitis B. Cirrhosis from causes other than NAFLD and ALD will nearly cease to be an important public health concern in the coming decades, Flemming’s data suggested.
Overall, the data indicate that NAFLD is far and away the most important cause of liver cirrhosis in Ontarian women (which is racially and ethnically diverse and is most like the U.S. among Canadian provinces).
Yet mortality data presented by Flemming show a different picture, with NAFLD not even in the top three causes of cirrhosis death in women. Leading was alcoholic cirrhosis at 8.7 per 100 person-years, followed by “other” and autoimmune disease at 5.74 and 5.22 per 100 person-years. Then came NAFLD at 4.10 per 100. This pattern could reflect the overall epidemiology of NAFLD, which is mainly a complication of obesity — a public health problem of relatively recent onset.
Flemming said both NAFLD and ALD are modifiable factors in liver-related morbidity and mortality. She recommended “public health education specifically directed to women” on risks related to