Original ResearchFull Report: Clinical—LiverTrends in Burden of Cirrhosis and Hepatocellular Carcinoma by Underlying Liver Disease in US Veterans, 2001–2013
Section snippets
Data Source: Veterans Affairs Corporate Data Warehouse
The VA health care system is composed of 154 medical centers and 875 ambulatory care and community-based outpatient clinics throughout the United States. It is the largest integrated health care provider in the country and uses electronic medical records almost exclusively. In 2013, 5,720,614 veterans received VA health care.10 We extracted electronic data for all patients in VA care from October 1, 1999 until July 21, 2014, using the VA Corporate Data Warehouse, a national, continually updated
Characteristics of Patients With Cirrhosis or HCC in 2013
Of 5,720,614 patients in VA care in 2013, 60,553 patients (1.06%) had cirrhosis and 7,670 (0.13%) had HCC. Among patients with cirrhosis, 28,811 (48%) had HCV infection (60.9% of whom also had a chronic alcohol-related diagnosis), 18,404 (30%) had ALD, 9027 (15%) had NAFLD, 1299 (2.1%) had HBV infection, and 1737 (2.9%) had cryptogenic cirrhosis, while <1% had hemochromatosis, PSC, PBC, or AIH (Table 1). The average age was 62.4 years; 77% were white, 18% were black, and 8.7% were Hispanic. The
Discussion
The national prevalence and mortality of cirrhosis in VA health care users increased approximately 2-fold and 1.5-fold, respectively, between 2001 and 2013, whereas the incidence and mortality of HCC increased nearly 3-fold. If current trends continue, our data suggest that the prevalence of cirrhosis will peak in 2021. In contrast, the incidence of HCC continues to increase, confirming worrisome predictions of rapid growth put forward by work conducted in the mid-2000s.7
These trends were
Acknowledgements
The authors thank Dr Anna S. F. Lok for many valuable contributions to our analyses and manuscript preparation and the HIV, Hepatitis, and Public Health Pathogens Program of the Office of Public Health, Department of Veterans Affairs, for its commitment to treating hepatitis C virus and other liver diseases in veterans. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.
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This article has an accompanying continuing medical education activity on page e17. Learning Objective: Upon completion of this exam, successful learners will be able to (1) describe trends and predictions related to the prevalence, incidence, and etiology of cirrhosis in US Veterans; (2) describe trends and predictions related to the prevalence, incidence, and etiology of hepatocellular carcinoma in US Veterans; (3) Identify factors associated with HCV-related cirrhosis.
Conflicts of interest The authors have no conflicts of interest to disclose.
Funding This study was supported by Merit Review grant I01CX000320, Clinical Science Research and Development, Office of Research and Development, Veterans Affairs (G.N.I.) and by the HIV, Hepatitis, and Public Health Pathogens Program of the Office of Public Health, Department of Veterans Affairs (L.A.B.). The sponsors had no role in study design or collection, analysis or interpretation of the data.