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Liver and Heart Disease, Nonsolid Cancers, Lead Causes of Death With NAFLD
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EASL 2020, Digital International Liver Congress, August 27-29, 2020
Mark Mascolini
Liver disease led causes of death among people who died with nonalcoholic fatty liver disease (NAFLD) in a 2.8 million-person US study [1]. Heart disease and nonsolid tumors ranked second and third as death causes with NAFLD. Liver disease, heart disease, and nonsolid tumors also led the list of death causes for people with any chronic liver disease.
NAFLD stands as the leading cause of chronic liver disease and a principal cause of liver-related mortality, note Inova Health System and Johns Hopkins Hospital researchers who led this study. But because most data on cause of death with NAFLD come from tertiary care centers, they observe, there is no population-level analysis of comparable and consistent causes of death in US residents with NAFLD.
To conduct such a population-level analysis, the researchers scrutinized data from the National Vital Statistics System (NVSS) maintained by the National Center for Health Statistics (NCHS). The NVSS captures more than 99% of deaths in the United States. The system uses ICD-10 codes to record underlying and contributing causes of death.
The study population included everyone at least 20 years old when they died in 2017 or 2018. Chronic liver disease included chronic hepatitis C and B, alcoholic liver disease, and NAFLD. The researchers ranked leading causes of death according to the number of deaths assigned to 51 potential causes by the NCHS. This analysis also considered two other causes of death: liver death (liver cancer, cirrhosis, or chronic liver disease) and nonliver cancer death (any cancer except liver cancer).
The analysis involved 2,826,531 US residents at least 20 years old who died in 2018, including 88,679 people (3.14%) who had chronic liver disease. Among those who died with chronic liver disease, 79.3% had cirrhosis, 50.6% had NAFLD, 31.3% had alcoholic liver disease, 13.1% had chronic hepatitis C, 6.4% had hepatocellular carcinoma (HCC), 0.3% had chronic hepatitis B, and 18.5% had no complications.
Among 88,679 people who died with chronic liver disease in 2018, the leading causes of death were liver disease (59.4%), heart disease (7.95%), and nonliver cancer (6.04%). From 2017 to 2018 in this population, deaths from liver-related cancer rose significantly by 0.4% and from nonliver cancer by 6.8%. Among people who died with chronic liver disease, liver-related problems were the leading cause of death, compared with the twelfth leading cause of death in the general population. Diabetes ranked as the fifth leading cause of death in people with chronic liver disease, compared with the seventh leading cause in the general population. Septicemia emerged as the seventh leading cause of death in people with chronic liver disease, compared with the eleventh leading cause in the general population.
In people with NAFLD, liver disease held first place among causes of death (45.8%), followed again by heart disease (10.3%) nonliver cancer (6.9%), and diabetes (2.7%). The leading cancer causes of death in people with NAFLD were liver cancer (41.2%), lung cancer (9.0%), and nonsolid cancers (7.6%). For people with alcoholic liver diseases, the leading cancer causes of death were liver cancer (55.1%), colorectal cancer (4.5%), and pancreatic cancer (4.3%). Leading cancer causes of death for people with chronic HCV were liver cancer (66%), lung cancer (8.3%), nonsolid cancers (3.6%), and pancreatic cancer (3.6%).
The four cancer deaths whose rates changed most from 2017 to 2018 in people with NAFLD were liver cancer (+1.9%), nonsolid cancers (+1.5%), lung cancer (+1.2%), and colorectal cancer (+1.2%). Among people with alcoholic liver disease, the greatest changes in rates of cancer deaths from 2017 to 2018 were liver cancer (+4.3%), oral cancer (-2.0%), kidney cancer (+1.6%), and breast, esophageal, and nonsolid cancers (all +1.1%). And among people with chronic HCV infection, the greatest changes in cancer death rates from 2017 to 2018 were liver cancer (-5.5%), oral cancer (-0.9%), pancreatic cancer (+0.6%), and colorectal cancer (-0.4%).
Among all cancer causes of death in people with NAFLD, risk of death for each cancer was 1.3- to 5-fold higher in men than women. Compared with whites with NAFLD, blacks ran a higher risk of death from liver, prostate, stomach, and uterine cancer. Compared with non-Hispanic whites, Hispanics with NAFLD were more likely to die from liver, kidney, and stomach cancer. And whites with NAFLD were more likely to die from lung, esophageal, oral, and skin cancer.
Reference
1. Paik J, Golabi P, Deavila L, et al. Causes of death in patients with nonalcoholic fatty liver disease (NAFLD): data from National Vital Statistics System (NVSS). EASL 2020, Digital International Liver Congress, August 27-29, 2020. Abstract AS158.
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