Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, 100034, China.
Department of Infectious Diseases, Peking University International Hospital, Beijing, 102206, China.
Hepatol Int. 2024 Feb;18(1):238-253. doi: 10.1007/s12072-023-10531-y. Epub 2023 Apr 26.
BACKGROUND & AIMS: Cirrhosis was the leading cause of morbidity and mortality in adults, but data on the burden and trends were sparse in children and adolescents. We aimed to assess the trends in 204 countries and territories over the past 30 years in children and adolescents aged 0-19 years.
Data on cirrhosis was collected by the Global Burden of Disease (GBD) 2019 database from 1990 to 2019. We reported on the number, rates, and average annual percentage changes (AAPCs) of incidence and disability-adjusted life-years (DALYs) of cirrhosis at global, regional, and national level.
Globally, the incident numbers of cirrhosis in children and adolescents increased from 204,767 in 1990 to 241,364 in 2019, an increase of 17.9%, with an AAPC 0.13(0.10 to 0.16). Prevalence (AAPC = - 2.27[- 2.39 to - 2.15]), mortality (AAPC = - 1.68 [- 1.86 to - 1.5]), and DALYs rate (AAPC = - 1.72[- 1.88 to - 1.56]) of cirrhosis have decreased significantly. Cirrhosis incident rates varied between different ages. Cirrhosis caused by alcohol use (AAPC = 1[0.8 to 1.1]; incidence cases increased 48%), hepatitis C (AAPC = 0.4 [0.4 to 0.5]), NAFLD (AAPC = 0.5 [0.3 to 0.6]) have been increasing, while only hepatitis B (- 0.3[- 0.4 to - 0.2]) decreasing. Incidence cases of cirrhosis were increased in low (101.6%) and low-middle sociodemographic index (SDI 21.1%) areas, while decreasing in middle and above SDI areas. At the regional level, the largest increases count was observed in Sub-Saharan Africa.
Global incidence rate of cirrhosis has been increasing, while the DALYs rate has been decreasing in children and adolescents. Morbidity of cirrhosis caused by hepatitis B declined, while hepatitis C, NAFLD, and alcohol use increased.
肝硬化是导致成年人发病和死亡的主要原因，但有关儿童和青少年负担和趋势的数据却很少。我们旨在评估过去 30 年来全球 204 个国家和地区 0-19 岁儿童和青少年的肝硬化趋势。
全球疾病负担（GBD）2019 数据库收集了肝硬化的数据。我们在全球、区域和国家层面报告了肝硬化的发病数量、发病率、残疾调整生命年（DALYs）以及发病率和 DALYs 的年平均百分比变化（AAPC）。
全球范围内，儿童和青少年肝硬化的发病数量从 1990 年的 204767 例增加到 2019 年的 241364 例，增长了 17.9%，AAPC 为 0.13（0.10-0.16）。肝硬化的患病率（AAPC=-2.27[-2.39 至-2.15]）、死亡率（AAPC=-1.68[-1.86 至-1.5]）和 DALYs 率（AAPC=-1.72[-1.88 至-1.56]）均显著下降。肝硬化的发病年龄存在差异。由酒精使用引起的肝硬化（AAPC=1[0.8-1.1]；发病病例增加 48%）、丙型肝炎（AAPC=0.4[0.4-0.5]）、非酒精性脂肪性肝病（NAFLD，AAPC=0.5[0.3-0.6]）有所增加，而乙型肝炎（-0.3[-0.4 至-0.2]）则有所减少。在低（101.6%）和中低社会人口指数（SDI 21.1%）地区，肝硬化的发病病例增加，而在中高 SDI 地区则减少。在区域层面，撒哈拉以南非洲的增幅最大。
全球范围内，儿童和青少年的肝硬化发病率一直在上升，而 DALYs 率则在下降。乙型肝炎引起的肝硬化发病率下降，而丙型肝炎、NAFLD 和酒精使用则有所增加。
