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Epidemiology, disease burden and outcomes of cirrhosis in a large secondary care hospital in South Auckland, New Zealand

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Summary:

In this study, cirrhosis complications and mortality data were retrospectively analysed from 746 cirrhosis patients under secondary public hospital care in South Auckland, between the years 2000 and 2011. Ethnicities were mostly European/Other (39.9%), Pacific islanders (21.6%), Southeast Asian/ Chinese (17.8%) and Maori (12.3%). 68.4% of the cohort 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-years, respectively), compared with ALD and CHC groups (2.2 and 1.4 per 100 patient-years; p<0.05 for all comparisons). Higher rates of all-cause and non-HCC mortality were observed among patients with ALD and NAFLD cirrhosis compared with viral hepatitis cirrhosis cohorts. Incidence rate ratios (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.

Comment:
For me, this study highlights the fact that hepatitis B and C, as well as non-alcoholic fatty liver disease, are major causes for cirrhosis and liver cancer in Aotearoa. The discourse about higher rates of liver disease in indigenous people – from clinicians and communities – focuses on alcohol. These results suggest more can be done to prevent and manage infectious and non-communicable (such as diabetes) risk factors.
Reference: Intern Med J. 2015;45(2):160-9
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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