Observational studyBMJ open2017
Liver cirrhosis in England-an observational study: are we measuring its burden occurrence correctly?
Observational study in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Systematic review: development of a consensus code set to identify cirrhosis in electronic health records.Alimentary pharmacology & therapeutics · 2022Pooled it
- Identifying emergency presentations of chronic liver disease using routinely collected administrative hospital data.JHEP reports : innovation in hepatology · 2025Article
- Observational
- Lower incidence of hepatocellular carcinoma with tenofovir alafenamide in chronic hepatitis B: Evidence from a large-scale cohort.JHEP reports : innovation in hepatology · 2025Article
- Effect ofHeliyon · 2024Article
- Observational
- Bioengineering liver tissue by repopulation of decellularised scaffolds.World journal of hepatology · 2023Review
- Rising incidence, progression and changing patterns of liver disease in Wales 1999-2019.World journal of hepatology · 2023Article
- Morbimortality Associated with Liver Cirrhosis in Peru: An Ecological Analysis for the Period of 2004-2016.International journal of environmental research and public health · 2022Article
- Association of physical activity with risk of hepatobiliary diseases in China: a prospective cohort study of 0.5 million people.British journal of sports medicine · 2021Article
- Assessing the contribution of alcohol-specific causes to socio-economic inequalities in mortality in England and Wales 2001-16.Addiction (Abingdon, England) · 2020Article
- Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2020Review
- Clinical Ontologies Improve Case Finding of Primary Biliary Cholangitis in UK Primary and Secondary Care.Digestive diseases and sciences · 2020Article
- Observational and Genetic Associations of Body Mass Index and Hepatobiliary Diseases in a Relatively Lean Chinese Population.JAMA network open · 2020Observational
- The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.The lancet. Gastroenterology & hepatology · 2020Article
- Shape of Training Review: an impact assessment for UK gastroenterology trainees.Frontline gastroenterology · 2019Article
- Observational
- Current trends of liver cirrhosis in Mexico: Similitudes and differences with other world regions.World journal of clinical cases · 2018Article
- Measurement of liver iron by magnetic resonance imaging in the UK Biobank population.PloS one · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesMortality due to liver disease (of which cirrhosis is the end stage) is increasing more than any other chronic condition in the UK. This study aims to demonstrate that (1) exclusive reliance on mortality rates may not reveal the true burden of liver cirrhosis, and (2) diverse use of diagnostic coding may produce misleading estimates.
designObservational study.
settingThe Office for National Statistics death registry was interrogated to investigate liver cirrhosis mortality trends in England and Wales from 1968 to 2011. MAIN OUTCOME: Standardised mortality trends according to three different definitions of liver cirrhosis based on the specificity of diagnostic codes were calculated: 1 (chronic liver diseases), 2 (alcoholic and unspecified cirrhosis only) and 3 (cirrhosis as end-stage liver disease). The mortality trends were compared with incidence rates established in a previous population-based study (based on definition 3), from 1998 to 2009, to investigate discrepancies between these two measures.
resultsOver the study period, the overall standardised liver cirrhosis mortality rates were 8.8, 5,1 and 5.4 per 100 000 person-years for definitions 1, 2 and 3, respectively. The mortality rates for definition 3 in 1998 and 2009 were 6.2 and 5.9 per 100 000 person-years, respectively; while the equivalent incidence rates were at least threefold and sixfold higher: 23.4 and 35.9 per 100 000 person-years, respectively. This discrepancy between incidence and mortality rates was also at least threefold in men and women separately and across age groups.
conclusionMortality rates underestimated the incidence of liver cirrhosis by at least threefold between 1998 and 2009 and varied with differing definitions of disease. Mortality data should not be used exclusively as an indicator for the occurrence of liver cirrhosis in the population. Routinely collected healthcare data are available to measure occurrence of this disease. Careful consideration should be taken when selecting diagnostic codes for cirrhosis.
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