Worldwide patterns and trends in mortality from liver cirrhosis, 1955 to 1990

Trends in mortality rates for liver cirrhosis between 1955 and 1990 have been analyzed for 38 countries (two from North America, six from Latin America, five from Asia, 23 from Europe, and Australia and New Zealand) on the basis of official death certification data derived from the World Health Organization database. Chile and Mexico had exceedingly high rates (around 60/100,000 males and 15/100,000 females in the late 1980s), while in Canada, the United States, and Latin American countries that provided data, cirrhosis death rates were between 5 and 17/100,000 males and 3 and 5/100,000 females over the same calendar period. The pattern of trends was, however, similar in all American countries, with some increase between the 1950s and the 1970s, and declines thereafter. A similar trend was observed in Japanese males, whose rate was 13.6 in 1990. Conversely, cirrhosis mortality declined steadily from 8.0 to 4.6 in Japanes females. Appreciable downward trends were observd in Hong Kong and Singapore, whereas mortality increased in Thailand. In Europe, in the late 1950s, the highest rates were registered in Portugal (33.6/100,000 males and 14.6/100,000 females), followed by France (31.8/100,000 males and 14.1/100,000 females), Austria, Italy, Spain, and Germany. Most of these countries, however, after some further rise up to the 1970s, showed reversal of the trends over most recent years. Thus, in the late 1980s or early 1990s, only Austria, Italy, and Portugal had cirrhosis mortality around 30/100,000 males and 10/100,000 females. Britain, Ireland, and Nordic countries started from much lower values (2 to 4/100,000 males), but showed some, although discontinuous, upward trend. Eastern European countries also started with relatively low values in the early 1950s, but experienced steady and substantial rises thereafter. Thus, over most recent years, the highest rates were in Hungary (57.5/100,000 males and 22.0/100,000 females), Romania (34.8/100,000 males and 17.1/100,000 females), Czechoslovakia, and former Yugoslavia. These findings are discussed with reference to known risk factors for liver cirrhosis (hepatitis B virus and alcohol consumption) and their public health implications, particularly for central and eastern Europe.