title: The epidemiology of newly diagnosed chronic liver disease in gastroenterology practices in the United States: results from population-based surveillance.
abstract: OBJECTIVE
  Chronic liver disease (CLD) is an important cause of morbidity and mortality, but the epidemiology is not well described. We conducted prospective population-based surveillance to estimate newly diagnosed CLD incidence, characterize etiology distribution, and determine disease stage.
  
  
  METHODS
  We identified cases of CLD newly diagnosed during 1999-2001 among adult county residents seen in any gastroenterology practice in New Haven County, Connecticut; Multnomah County, Oregon; and Northern California Kaiser Permanente Medical Care Program (KPMCP, Oakland, California [total population 1.48 million]). We defined CLD as abnormal liver tests of at least 6 months' duration or pathologic, clinical, or radiologic evidence of CLD. Consenting patients were interviewed, a blood specimen obtained, and the medical record reviewed.
  
  
  RESULTS
  We identified 2,353 patients with newly diagnosed CLD (63.9 cases/100,000 population), including 1,225 hepatitis C patients (33.2 cases/100,000). Men aged 45-54 yr had the highest hepatitis C incidence rate (111.3/100,000). Among 1,040 enrolled patients, the median age was 48 yr (range 19-86 yr). Hepatitis C, either alone (442 [42%]) or in combination with alcohol-related liver disease (ALD) (228 [22%]), accounted for two-thirds of the cases. Other etiologies included nonalcoholic fatty liver disease (NAFLD, 95 [9%]), ALD (82 [8%]), and hepatitis B (36 [3%]). Other identified etiologies each accounted for <3% of the cases. A total of 184 patients (18%) presented with cirrhosis, including 44% of patients with ALD.
  
  
  CONCLUSIONS
  Extrapolating from this population-based surveillance network to the adult U.S. population, approximately 150,000 patients with CLD were diagnosed in gastroenterology practices each year during 1999-2001. Most patients had hepatitis C; heavy alcohol consumption among these patients was common. Almost 20% of patients, an estimated 30,000 per year, had cirrhosis at presentation. These results provide population-level baseline data to evaluate trends in identification of patients with CLD in gastroenterology practices.
authors.affiliation: Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Beth P
authors.initials: BP
authors.lastname: Bell
authors.forename: M Michele
authors.initials: MM
authors.lastname: Manos
authors.forename: Atif
authors.initials: A
authors.lastname: Zaman
authors.forename: Norah
authors.initials: N
authors.lastname: Terrault
authors.forename: Ann
authors.initials: A
authors.lastname: Thomas
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Navarro
authors.forename: Kathy B
authors.initials: KB
authors.lastname: Dhotre
authors.forename: Rosemary C
authors.initials: RC
authors.lastname: Murphy
authors.forename: Grace R
authors.initials: GR
authors.lastname: Van Ness
authors.forename: Nicole
authors.initials: N
authors.lastname: Stabach
authors.forename: Marie E
authors.initials: ME
authors.lastname: Robert
authors.forename: William A
authors.initials: WA
authors.lastname: Bower
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Bialek
authors.forename: Andre N
authors.initials: AN
authors.lastname: Sofair
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D014481:United States / Q000453:epidemiology; D055815:Young Adult