Liver-related mortality in countries of the developed world: an ecological study approach to explain the variability

M. von Wulffen, P. J. Clark, G. A. Macdonald, A. S. Raj, B. J. Kendall, E. E. Powell, M. P. Jones, G. Holtmann

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Liver-related mortality varies across developed nations. Aim: To assess the relative role of various risk factors in relation to liver-related mortality in an ecological study approach. Methods: Data for liver-related mortality, prevalence data for hepatitis B and C, human immunodeficiency virus (HIV), alcohol consumption per capita, Type 2 Diabetes mellitus (T2DM), overweight and obesity were extracted from peer-reviewed publications or WHO databases for different developed countries. As potential other risk-modifying factors, purchase power parity (PPP)-adjusted gross domestic product (GDP) per capita and health expenditure per capita were assessed. As an environmental ‘hygiene factor’, we also assessed the effect of the prevalence of Helicobacter pylori. Only countries with a PPP-adjusted GDP greater than $20 000 and valid information for at least 8 risk modifiers were included. Univariate and multivariate analyses were utilised to quantify the contribution to the variability in liver-related mortality. Results: The proportion of chronic liver diseases (CLD)-related mortality ranged from 0.73–2.40% [mean 1.56%, 95% CI (1.43–1.69)] of all deaths. Univariately, CLD-related mortality was significantly associated with Hepatitis B prevalence, alcohol consumption, PPP-adjusted GDP (all P < 0.05) and potentially H. pylori prevalence (P = 0.055). Other investigated factors, including hepatitis C, did not yield significance. Backward elimination suggested hepatitis B, alcohol consumption and PPP-adjusted GDP as risk factors (explaining 66.3% of the variability). Conclusion: Hepatitis B infection, alcohol consumption and GDP, but not hepatitis C or other factors, explain most of the variance of liver-related mortality.

LanguageEnglish
Pages68-77
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume44
Issue number1
DOIs
Publication statusPublished - 1 Jul 2016

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Developed Countries
Gross Domestic Product
Parity
Mortality
Hepatitis B
Liver
Alcohol Drinking
Hepatitis C
Helicobacter pylori
Liver Diseases
Chronic Disease
Health Expenditures
Hygiene
Type 2 Diabetes Mellitus
Publications
Multivariate Analysis
Obesity
HIV
Databases
Power (Psychology)

Cite this

von Wulffen, M., Clark, P. J., Macdonald, G. A., Raj, A. S., Kendall, B. J., Powell, E. E., ... Holtmann, G. (2016). Liver-related mortality in countries of the developed world: an ecological study approach to explain the variability. Alimentary Pharmacology and Therapeutics, 44(1), 68-77. https://doi.org/10.1111/apt.13657
von Wulffen, M. ; Clark, P. J. ; Macdonald, G. A. ; Raj, A. S. ; Kendall, B. J. ; Powell, E. E. ; Jones, M. P. ; Holtmann, G. / Liver-related mortality in countries of the developed world : an ecological study approach to explain the variability. In: Alimentary Pharmacology and Therapeutics. 2016 ; Vol. 44, No. 1. pp. 68-77.
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abstract = "Background: Liver-related mortality varies across developed nations. Aim: To assess the relative role of various risk factors in relation to liver-related mortality in an ecological study approach. Methods: Data for liver-related mortality, prevalence data for hepatitis B and C, human immunodeficiency virus (HIV), alcohol consumption per capita, Type 2 Diabetes mellitus (T2DM), overweight and obesity were extracted from peer-reviewed publications or WHO databases for different developed countries. As potential other risk-modifying factors, purchase power parity (PPP)-adjusted gross domestic product (GDP) per capita and health expenditure per capita were assessed. As an environmental ‘hygiene factor’, we also assessed the effect of the prevalence of Helicobacter pylori. Only countries with a PPP-adjusted GDP greater than $20 000 and valid information for at least 8 risk modifiers were included. Univariate and multivariate analyses were utilised to quantify the contribution to the variability in liver-related mortality. Results: The proportion of chronic liver diseases (CLD)-related mortality ranged from 0.73–2.40{\%} [mean 1.56{\%}, 95{\%} CI (1.43–1.69)] of all deaths. Univariately, CLD-related mortality was significantly associated with Hepatitis B prevalence, alcohol consumption, PPP-adjusted GDP (all P < 0.05) and potentially H. pylori prevalence (P = 0.055). Other investigated factors, including hepatitis C, did not yield significance. Backward elimination suggested hepatitis B, alcohol consumption and PPP-adjusted GDP as risk factors (explaining 66.3{\%} of the variability). Conclusion: Hepatitis B infection, alcohol consumption and GDP, but not hepatitis C or other factors, explain most of the variance of liver-related mortality.",
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Liver-related mortality in countries of the developed world : an ecological study approach to explain the variability. / von Wulffen, M.; Clark, P. J.; Macdonald, G. A.; Raj, A. S.; Kendall, B. J.; Powell, E. E.; Jones, M. P.; Holtmann, G.

In: Alimentary Pharmacology and Therapeutics, Vol. 44, No. 1, 01.07.2016, p. 68-77.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Liver-related mortality in countries of the developed world

T2 - Alimentary Pharmacology and Therapeutics

AU - von Wulffen, M.

AU - Clark, P. J.

AU - Macdonald, G. A.

AU - Raj, A. S.

AU - Kendall, B. J.

AU - Powell, E. E.

AU - Jones, M. P.

AU - Holtmann, G.

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Y1 - 2016/7/1

N2 - Background: Liver-related mortality varies across developed nations. Aim: To assess the relative role of various risk factors in relation to liver-related mortality in an ecological study approach. Methods: Data for liver-related mortality, prevalence data for hepatitis B and C, human immunodeficiency virus (HIV), alcohol consumption per capita, Type 2 Diabetes mellitus (T2DM), overweight and obesity were extracted from peer-reviewed publications or WHO databases for different developed countries. As potential other risk-modifying factors, purchase power parity (PPP)-adjusted gross domestic product (GDP) per capita and health expenditure per capita were assessed. As an environmental ‘hygiene factor’, we also assessed the effect of the prevalence of Helicobacter pylori. Only countries with a PPP-adjusted GDP greater than $20 000 and valid information for at least 8 risk modifiers were included. Univariate and multivariate analyses were utilised to quantify the contribution to the variability in liver-related mortality. Results: The proportion of chronic liver diseases (CLD)-related mortality ranged from 0.73–2.40% [mean 1.56%, 95% CI (1.43–1.69)] of all deaths. Univariately, CLD-related mortality was significantly associated with Hepatitis B prevalence, alcohol consumption, PPP-adjusted GDP (all P < 0.05) and potentially H. pylori prevalence (P = 0.055). Other investigated factors, including hepatitis C, did not yield significance. Backward elimination suggested hepatitis B, alcohol consumption and PPP-adjusted GDP as risk factors (explaining 66.3% of the variability). Conclusion: Hepatitis B infection, alcohol consumption and GDP, but not hepatitis C or other factors, explain most of the variance of liver-related mortality.

AB - Background: Liver-related mortality varies across developed nations. Aim: To assess the relative role of various risk factors in relation to liver-related mortality in an ecological study approach. Methods: Data for liver-related mortality, prevalence data for hepatitis B and C, human immunodeficiency virus (HIV), alcohol consumption per capita, Type 2 Diabetes mellitus (T2DM), overweight and obesity were extracted from peer-reviewed publications or WHO databases for different developed countries. As potential other risk-modifying factors, purchase power parity (PPP)-adjusted gross domestic product (GDP) per capita and health expenditure per capita were assessed. As an environmental ‘hygiene factor’, we also assessed the effect of the prevalence of Helicobacter pylori. Only countries with a PPP-adjusted GDP greater than $20 000 and valid information for at least 8 risk modifiers were included. Univariate and multivariate analyses were utilised to quantify the contribution to the variability in liver-related mortality. Results: The proportion of chronic liver diseases (CLD)-related mortality ranged from 0.73–2.40% [mean 1.56%, 95% CI (1.43–1.69)] of all deaths. Univariately, CLD-related mortality was significantly associated with Hepatitis B prevalence, alcohol consumption, PPP-adjusted GDP (all P < 0.05) and potentially H. pylori prevalence (P = 0.055). Other investigated factors, including hepatitis C, did not yield significance. Backward elimination suggested hepatitis B, alcohol consumption and PPP-adjusted GDP as risk factors (explaining 66.3% of the variability). Conclusion: Hepatitis B infection, alcohol consumption and GDP, but not hepatitis C or other factors, explain most of the variance of liver-related mortality.

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U2 - 10.1111/apt.13657

DO - 10.1111/apt.13657

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