title: Epidemiology, disease burden and outcomes of cirrhosis in a large secondary care hospital in South Auckland, New Zealand.
abstract: BACKGROUND
  Liver cirrhosis is an important cause of morbidity and mortality; however, little is known about its impact in New Zealand.
  
  
  OBJECTIVE
  We aim to determine the disease burden, epidemiology and outcomes of cirrhotic patients.
  
  
  METHODS
  This is a retrospective study of cirrhosis patients under secondary public hospital care in a geographically defined region, between the years 2000 and 2011. Cirrhosis complications and mortality was recorded. Poisson log-linear regression analysis was performed for incidence rate ratio (IRR) and Cox regression analysis was used to analyse time-related events.
  
  
  RESULTS
  Seven hundred and forty-six cirrhotic patients were analysed; most were European/Other (39.9%), Pacific islanders (21.6%), Southeast Asian/Chinese (17.8%) and Maori (12.3%). 68.4% were male. The common primary aetiologies for cirrhosis were chronic hepatitis B (CHB) cirrhosis (37.3%), alcoholic liver disease (ALD) cirrhosis (24.1%), chronic hepatitis C (CHC) cirrhosis (22.3%) and non-alcoholic fatty liver disease (NAFLD) cirrhosis (16.4%). The hepatocellular carcinoma (HCC) mortality rates were highest in NAFLD and CHB cirrhosis groups (3.0 and 3.1 per 100 patient-year respectively), compared with ALD and CHC groups (2.2 and 1.4 per 100 patient-year, all P < 0.05 respectively). Patients with ALD and NAFLD cirrhosis had the highest all-cause and non-HCC mortality rate compared with viral hepatitis cirrhosis groups. The IRR for HCC incidence, liver-related mortality and HCC mortality were 1.087, 1.098 and 1.114, respectively (all P < 0.001), suggesting increasing incidence and disease burden over the study period.
  
  
  CONCLUSIONS
  The number of cirrhotic patients in secondary care is increasing steadily. Cirrhosis complications and mortality rates are also rising, particularly the incidence and mortality of HCC.
authors.affiliation: Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand.
authors.forename: J C
authors.initials: JC
authors.lastname: Hsiang
authors.forename: W W
authors.initials: WW
authors.lastname: Bai
authors.forename: Z
authors.initials: Z
authors.lastname: Raos
authors.forename: W
authors.initials: W
authors.lastname: Stableforth
authors.forename: A
authors.initials: A
authors.lastname: Upton
authors.forename: S
authors.initials: S
authors.lastname: Selvaratnam
authors.forename: E J
authors.initials: EJ
authors.lastname: Gane
authors.forename: S J
authors.initials: SJ
authors.lastname: Gerred
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D018450:Disease Progression; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D016012:Poisson Distribution; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D063127:Secondary Health Care / Q000379:methods; D012720:Severity of Illness Index; D016019:Survival Analysis; D014505:Urban Population
keywords: cirrhosis; cirrhosis mortality; hepatocellular carcinoma; liver complication; non-alcoholic liver disease; viral hepatitis