Trends in mortality and years of life lost among patients with cirrhosis and hepatocellular carcinoma in France, 2011-2023: a nationwide retrospective population-based study.

Abstract

The burden of cirrhosis and hepatocellular carcinoma (HCC) due to alcohol (ALC), viral hepatitis (VIR) and metabolic syndrome (MS) has evolved. Mortality analysis, including premature deaths, is important for public health decision-makers. This study aimed to assess mortality trends and years of life lost (YLL) in these patients. Data from patients hospitalised with at least one ICD-10 code of cirrhosis and/or HCC were extracted from the French Medical Information System Program from 2011 to 2023. Liver and extrahepatic age-standardised mortality rates (ASMR, per 100,000), age at death (years) and YLL were assessed by aetiology. Death occurred in 219,587/543,208 cirrhotic/HCC patients; ALC, VIR and MS represented 91.5% of deaths (200,854/219,587), two-thirds of deaths are liver-related (141,030/219,587). Death occurred earlier in VIR (mean 64.8 [SD 13.4] years) or ALC (66.8 [10.9] years) than in MS (75.1 [10.2] years; p < 0.0001) patients. Three out of 5 liver-related deaths were HCC-related in VIR and MS while 2/3 were liver-failure-related in ALC. From 2011 to 2023 ALC was the primary cause of liver-related deaths (71.0%-64.6%), VIR was second until 2016 then MS became second (13.6%-8.9% and 9.0%-16.6%, respectively). Liver-related ASMRs decreased by 42.3% [42.8-44.0] in VIR and by 17.2% [16.8-17.6] in ALC, and increased by 56.3% [52.9-60.0] in MS. YLL per individual were twice as high in VIR (16.8 [16.6-16.9] years) and ALC (14.3 [14.3-14.4] years) than MS (7.8 [7.7-7.9] years), and the highest (21.9 [21.7-22.1] years) in VIR with alcohol dependence. COVID-19 era saw increased ASMRs and proportion of non-liver related deaths. Deaths mainly occurred from liver failure in ALC and from HCC in VIR and MS. Despite 40%-decrease of mortality in VIR, premature mortality remains a major issue in ALC and VIR. These findings highlight the need for targeted public health and clinical strategies, including early detection and prevention, to reduce the morbidity and mortality of liver disease. This work is supported by the French Institute for Public Health Research (IReSP), under the 2022 call for research projects to combat the use of and addiction to psychoactive substances with the reference IRESP-AAPSPA2022-V3-06.