To investigate the variations in death risk from cirrhosis across countries and understand the underlying factors contributing to these inequities, researchers, including Bajaj and Ashok K. Choudhury, M.D., a hepatologist and professor at the Institute for Liver and Biliary Sciences in India, collaborated with experts from around the globe. This collaborative research group, known as the Chronic Liver Disease Evolution And Registry for Events and Decompensation (CLEARED) Consortium, aimed to provide a comprehensive analysis of cirrhosis mortality from a global perspective.
The team collected and analyzed medical data from nearly 4,000 patients with cirrhosis, encompassing 90 medical centers in 25 countries across six continents. The data revealed that compared to patients treated in high-income countries, cirrhosis patients in lower-income countries faced a more than twofold increased risk of death in the hospital (8% vs. 22%) or within 30 days of discharge (14% vs. 30%).
“These results are very shocking and sobering. We did not anticipate such a wide disparity in cirrhosis mortality, but it shows that globally we are not on a level playing field when it comes to addressing advanced liver disease,” commented Bajaj, the lead author of the study.
Overcoming Disparities in Liver Cirrhosis Care and Saving Lives
The study also shed light on the global differences in medical resources that contribute to the divergence in mortality rates. The data indicated that cirrhosis patients in lower-income countries had limited access to affordable diagnostics, medications, therapies, intensive care units (ICUs), and liver transplants during hospitalization. Additionally, these patients were more likely to be hospitalized at advanced stages of the disease and had a higher prevalence of preventable conditions such as gastrointestinal bleeding and hepatitis B flare or infection. These findings suggest a lack of outpatient care and personal financial resources for patients in lower-income countries.
Bajaj emphasized the importance of initiating patient care for cirrhosis before hospitalization is necessary, emphasizing the significance of recognition, access to care, and affordability of treatment in preventing avoidable hospitalizations.
Addressing this issue requires public policy changes implemented by local governments to promote preventive healthcare and increase access to essential resources. Even incremental improvements in these areas can significantly enhance clinical outcomes for cirrhosis patients.
“While the current situation may seem daunting, given the rising prevalence of chronic health issues like diabetes, obesity, and alcohol use disorder that contribute to liver disease globally, there are steps we can take to change the course and save more lives. Raising awareness of these issues and prioritizing disease prevention are the foundation for meaningful change,” added Bajaj.
- Global disparities in mortality and liver transplantation in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium – (https:pubmed.ncbi.nlm.nih.gov/37230109/)