title: Trends of chronic liver disease in a tertiary care referral hospital in Eastern India.
abstract: BACKGROUND
  There is scarce Indian data on time trends of hepatitis, an impediment to formulate an effective public health policy on the matter.
  
  
  OBJECTIVE
  The aim was to study secular trends and burden of hepatitis in a railway population.
  
  
  METHODS
  Outdoor, indoor, endoscopy unit and mortality records of patients attending this hospital from January 2003 to December 2011 were searched manually and relevant parameters of hepatitis patients were noted, especially etiology, clinical features, treatment, and mortality. Cochran-Armitage trend test was used to test significance of any trend in these parameters. Binary logistic regression analysis of various factors was carried out to study their effect on the liver related mortality of hepatitis B and C cases and Kaplan-Meyer survival curves were generated for significant factors. Two-sided P < 0.05 was considered to be significant.
  
  
  RESULTS
  Chronic liver disease (CLD) due to alcohol showed a significant rising trend with early age (mean 48.4 years) and high percentage of decompensated disease (75%) at presentation and high early mortality (63%). No trend was observed for hepatitis B and C, but significant reduction in mortality was observed when definitive therapy was given. Cryptogenic CLD showed a decreasing trend though overall it still remained the most important etiology and survival was better compared with alcohol even with conservative therapy. Only 4% patients had hepatocellular carcinoma.
  
  
  CONCLUSIONS
  A menace of alcohol related liver disease affecting young productive work force in this part of India is foreseen, which might impact the country's economy and mandates immediate containment policy.
authors.affiliation: Head of Gastroenterology Unit, Department of Medicine, B R Singh Hospital, Kolkata, West Bengal, India.
authors.forename: Gautam
authors.initials: G
authors.lastname: Ray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006521:Hepatitis, Chronic; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000453:epidemiology* / Q000401:mortality; D008108:Liver Diseases, Alcoholic / Q000453:epidemiology; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D055815:Young Adult