title: Mortality from cirrhosis and hepatocellular carcinoma in Western Europe over the last 40 years.
abstract: Cirrhosis (LC) and hepatocellular carcinoma (HCC) are highly prevalent in Europe, with accompanying high mortality rates and social costs. As epidemiological data on these diseases are scarce, age-standardized death rate (ASDR) can serve as an indirect assessment of their burden.
  
  
  
  We analysed the ASDRs for LC and HCC from data reported in the WHO official death registries from 1970 to 2010, and compared ASDRs over the decades. The European Detailed Mortality Database was also used as source of data.
  
  
  
  In 1970, Portugal had the highest reported mortality for LC, followed by France and Italy. However, in 2010, Finland, Austria and Germany were respectively the three highest, while the UK showed the highest increase over those four decades (+284.8%). The annual ASDRs for LC have dropped in Europe from 20.4/105inhabitants in 1970 to 9.6 in 2010; a 53% decrease. For HCC, Spain, Italy and Denmark were ranked first through third, while in 2010 Italy, France and Luxembourg replaced them. Portugal had the highest increase (+654.7%). In 1980-2010, the ASDR for HCC in Europe increased from 3.4/105inhabitants to 6.3, up 85.4%. In the majority of nations-except for the UK, Finland and Ireland-there was a decrease in LC mortality and an increase for HCC mortality.
  
  
  
  The LC mortality rate is decreasing in Europe, yet there is a significant increase in HCC mortality. This phenomenon requires greater attention so we can understand the risk factors and implement preventive measures.
authors.affiliation: Department of Medicine, Centre for Liver Disease, Buon Consiglio - Fatebenefratelli Hospital, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ascione
authors.affiliation: Department of Medicine, Centre for Liver Disease, Buon Consiglio - Fatebenefratelli Hospital, Naples, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Fontanella
authors.affiliation: Department of Medicine, Centre for Liver Disease, Buon Consiglio - Fatebenefratelli Hospital, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Imparato
authors.affiliation: Department of Scienze Mediche Chirurgiche Neurologiche Metaboliche e dell'Invecchiamento, Second University of Naples, Naples, Italy.
authors.forename: Luca
authors.identifier: 0000-0002-6541-3821
authors.initials: L
authors.lastname: Rinaldi
authors.affiliation: Liver Unit, AORN Cardarelli, Naples, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: De Luca
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008113:Liver Neoplasms / Q000401:mortality*; D009026:Mortality / Q000639:trends
keywords: age-standardized death rate; cirrhosis mortality; hepatocellular carcinoma mortality; liver disease mortality