Worldwide mortality from cirrhosis: An update to 2002 Cristina Bosetti 1, * , Fabio Levi 2 , Franca Lucchini 2 , Witold A. Zatonski 3 , Eva Negri 1 , Carlo La Vecchia 1,4 1 Istituto di Ricerche Farmacologiche ‘‘Mario Negri’’, Via Eritrea 62, 20157 Milan, Italy 2 Registre Vaudois des Tumeurs, Institut Universitaire de Me ´decine Sociale et Pre ´ ventive (IUMSP), Universite ´ de Lausanne, CHUV Falaises 1, 1011 Lausanne, Switzerland 3 Cancer Epidemiology and Prevention Division, M Slodowska-Curie Memorial Cancer Centre, 02-781 Warsaw, Poland 4 Istituto di Statistica Medica e Biometria, Universita ` degli Studi di Milano, Via Venezian 1, 20133 Milan, Italy Background/ Aims: Cirrhosis mortality has registered large changes over the last few decades. Methods: Age-standardized (world standard) cirrhosis mortality rates per 100,000 were computed for 41 countries worldwide over the period 1980–2002 using data from the WHO mortality database. Results: In the early 1980s, the highest rates were in Mexico, Chile (around 55/ 100,000 men and over 14/100,000 women), France, Italy, Portugal, Austria, Hungary and Romania (around 30–35/100,000 men and 10–15/100,000 women). Mortality from cirrhosis has been steadily declining in most countries worldwide since the mid or late 1970s (annual percent change, APC, between À5% and À1.5% in the last decade only for both sexes). In southern Europe, rates in the early 2000s were less than halved compared to earlier decades. In contrast, rates have been rising in Eastern European countries to reach extremely high values in the mid 1990s, and declined only thereafter. In the UK rates were still steadily rising (APC around +7% in men and +3% in women from England and Wales, and +9% in men and +7% in women from Scotland). Conclusions: Mortality from cirrhosis shows favourable trends in most countries of the world, following the reduction in alcohol consumption and hepatitis B and C virus infection. The steady upward trends observed over more recent calendar periods in the UK and central and eastern European countries are attributed to the persistent increase in the prevalence of alcohol consumption. Ó 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. Keywords: Cirrhosis; Mortality; Trends 1. Introduction Cirrhosis is one of the major chronic diseases and causes of death, and has shown larger changes in mor- tality over the last few decades. In North America, mor- tality from cirrhosis has been declining since the early 1970s, to reach age-standardized (world population) rates around 10/100,000 men and 4–5/100,000 women in 1990 [1]. Rates also declined in other countries of the Americas, although in the early 1990s rates were still exceedingly high in Chile and Mexico (around 50/ 100,000 men and 15/100,000 women). Similar down- ward trends were observed in Japan (rates were about 14/100,000 men and 5/100,000 women in 1990), in Hong Kong and Singapore (rates below 10/100,000 men and below 3/100,000 women in 1990). Mortality from cir- rhosis continued to increase in men (rates around 9/ 100,000 men in 1990), but declined in women (rates around 3/100,000 in 1990) from Australia, and in both men and women from New Zealand (rates around 4/ 100,000 men and 2/100,000 women in 1990) [1]. In Europe, in the late 1970s the highest cirrhosis mortality rates (around 30–40/100,000 men and 10–16/100,000 women) were observed in Austria, 0168-8278/$32.00 Ó 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.jhep.2007.01.025 Received 6 December 2006; received in revised form 9 January 2007; accepted 24 January 2007; available online 16 February 2007 * Corresponding author. Tel.: +39 02 39014526; fax: +39 02 33200231. E-mail address: bosetti@marionegri.it (C. Bosetti). www.elsevier.com/locate/jhep Journal of Hepatology 46 (2007) 827–839