Rowe Ian A
University Academic Fellow, Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
Dig Dis. 2017;35(4):304-309. doi: 10.1159/000456580. Epub 2017 May 3.
Liver cirrhosis is responsible for more than 1 million deaths annually and the majority of these deaths are preventable. There is marked geographical variation in rates of mortality due to cirrhosis, and this variation in liver disease burden exemplifies the links between population risks for liver disease and mortality. The differing geographical distribution of the major risks factors for the development of liver disease including alcohol consumption, hepatitis C virus (HCV) infection, hepatitis B virus infection, and obesity and the metabolic syndrome has the potential to highlight opportunities for intervention, while the evolution of these risk factors provides insights into understanding the future burden of liver disease. This review focuses on the use of population data to identify high-risk areas and populations that would benefit from preventative interventions to reduce the mortality from liver disease. Specific strategies that are effective at the policy and public health levels are discussed to illustrate the impact these can have if widely implemented. The impact of therapies that have the potential to change the natural history of liver disease, including direct acting antivirals for HCV infection is also described. Finally, the challenges of describing the epidemiology of non-alcoholic fatty liver disease are highlighted to illustrate the need to understand the natural history of disease to inform and influence the development of novel therapies.
肝硬化每年导致超过100万人死亡，其中大多数死亡是可以预防的。肝硬化导致的死亡率存在显著的地理差异，这种肝病负担的差异体现了人群肝病风险与死亡率之间的联系。包括酒精消费、丙型肝炎病毒（HCV）感染、乙型肝炎病毒感染以及肥胖和代谢综合征在内的肝病主要危险因素的地理分布不同，这有可能凸显干预机会，而这些危险因素的演变有助于深入了解未来的肝病负担。本综述重点关注利用人群数据来确定可从预防干预措施中受益以降低肝病死亡率的高危地区和人群。讨论了在政策和公共卫生层面有效的具体策略，以说明这些策略如果广泛实施可能产生的影响。还描述了有可能改变肝病自然史的疗法的影响，包括用于HCV感染的直接作用抗病毒药物。最后，强调了描述非酒精性脂肪性肝病流行病学的挑战，以说明了解疾病自然史对于为新型疗法的开发提供信息和影响其发展的必要性。
