Age-period-cohort analysis and prediction of incidence and mortality of cirrhosis in China, 1990−2019

Objective To analyze the incidence and mortality of cirrhosis in China from 1990 to 2019 and provide data support for the prevention and treatment of cirrhosis.

Methods By using the 2019 Global Burden of Disease database, an age-period-cohort model analysis was conducted on the incidence and mortality of cirrhosis in China during this period. A Bayesian age-period-cohort model was used to predict the incidence and mortality rates of cirrhosis in China from 2020 to 2035. A percentage bar chart was drawn to analyze the proportion of causes of cirrhosis.

Results From 1990 to 2019, the overall incidence rate of cirrhosis increased by 9.88%, while the age-standardized incidence rate decreased by 16.85%, and the mortality rate decreased by 24.49%, and the age-standardized mortality rate decreased by 58.66% in China. The case count, incidence rate, death count, and mortality rate were higher in men than in women. The results of the age-period-cohort model showed that the net drift values of the incidence and mortality rates of cirrhosis were −1.08 95% confidence interval (CI): −2.07 to −0.07 and −3.75 (95%CI: −3.91 to −3.60), respectively, from 1990 to 2019. The incidence rate increased with age, peaking in the 45- age group and declining thereafter, while the mortality rate gradually increased with age. The risk for incidence and mortality decreased with year, and the incidence and mortality showed decreasing trends in later birth cohorts. It is predicted that the age-standardized incidence rate of cirrhosis would increase by 2.94% and the age-standardized mortality rate would decrease by 17.95% in China from 2020 to 2035. Hepatitis B virus infection was the main cause of cirrhosis, with its proportion decreasing from 40.27% in 2009 to 30.72% in 2019. The proportions of cirrhosis cases caused by hepatitis C virus infection and alcohol-related liver disease showed increasing trends.

Conclusion From 1990 to 2019, the incidence rate of cirrhosis increased and the mortality rate decreased in China. Both the age-standardized incidence rate and age-standardized mortality rate showed downward trends. It is predicted that the mortality rate of cirrhosis would significantly decrease from 2020 to 2035. Age, period, and birth cohort are all influencing factors. Further improvement of cirrhosis prevention and treatment strategies are needed, with particular attention paid to middle-aged and elderly groups.