title: Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe.
abstract: OBJECTIVE
  Over the last decades, Europe has experienced dramatic changes in the geographical variation of liver cirrhosis rates. We attempt to provide a comprehensive analysis of patterns and trends in liver cirrhosis mortality in European countries and regions.
  
  
  METHODS
  Age-standardized (world standard) liver cirrhosis mortality rates per 100,000 person-years at ages 20-64 for 35 separate countries were computed using the World Health Organization Mortality Database.
  
  
  RESULTS
  In the analyzed period (1959-2002), a very strong East-to-West gradient in mortality rates was observed. An increase of the burden of mortality due to liver cirrhosis appeared in Eastern Europe in two specific areas: South-eastern Europe and North-eastern Europe. In the first group of countries, liver cirrhosis mortality was 10-20 times higher than in most other European states, levels never before observed in Europe. In the countries of North-eastern Europe (former Soviet Union countries) liver cirrhosis mortality was characterized by dramatic changes (both positive and negative) in specific periods of time.
  
  
  CONCLUSIONS
  Despite the fact that the etiology of liver cirrhosis is multifactorial, it seems that alcohol drinking is the factor that best explains the observed patterns in frequency of this disease in Europe. Alcohol control policies in Central and Eastern Europe could lead to an appreciable reduction of premature mortality from liver cirrhosis.
authors.affiliation: The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cancer Epidemiology and Prevention Division, Warsaw, Poland. canepid@coi.waw.pl
authors.forename: Witold A
authors.initials: WA
authors.lastname: Zatoński
authors.forename: Urszula
authors.initials: U
authors.lastname: Sulkowska
authors.forename: Marta
authors.initials: M
authors.lastname: Mańczuk
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Albert B
authors.initials: AB
authors.lastname: Lowenfels
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
mesh_terms: D000328:Adult; D017677:Age Distribution; D000428:Alcohol Drinking / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors