Background: The incidence and prevalence of cirrhosis and overt hepatic encephalopathy (OHE), a serious complication of cirrhosis associated with recurrent and expensive hospitalizations, have increased over time.
Methods: Adults were identified from the MarketScan® Commercial Claims Database (aged 18-64 years) and the 100% Medicare Research Identifiable Files (aged ≥65 years) to calculate the annual prevalence of cirrhosis (≥2 International Classification of Diseases [ICD]-9/10 codes for cirrhosis or related complications) and OHE among patients with continuous health plan enrollment for that calendar year. Trends in prevalence (2007-2020) were extrapolated to 2030 using linear regression models, and average year-over-year (YOY) growth rates, and population counts (using 2030 population projections from the US Census Bureau) were estimated. Results were reported for the commercial and Medicare populations, separately, and stratified by sex and age (18-44 years, 45-64 years for commercial; 65-74 years, ≥75 years for Medicare).
Results: The prevalence of cirrhosis from 2007 to 2020 increased linearly from 0.23% to 0.45% and from 0.41% to 1.20% in the commercial and Medicare populations, representing 4.6% and 8.1% average YOY growth rates, respectively (both p<0.01; Figure 1). The prevalence of OHE from 2007 to 2020 increased linearly from 13.1% to 21.4% and from 15.2% to 20.9% in the commercial and Medicare populations, representing 4.3% and 2.5% average YOY growth rates respectively (both p<0.01; Figure 2).
Extrapolating observed trends forward from 2020, the predicted 2030 prevalence [95% prediction interval] of cirrhosis was 0.59% [0.50%, 0.69%; p<0.01] and 1.79% [1.61%, 1.98%; p<0.01] in the commercial and Medicare populations, representing 3.0% and 4.1% average YOY growth rates, respectively. The predicted 2030 prevalence of OHE among adults with cirrhosis was 28.5% [24.1, 33.0; p<0.01] and 26.7% [22.1%, 31.3%; p<0.01] in the commercial and Medicare populations, representing 2.9% and 1.9% average YOY growth rates, respectively. Increasing prevalence trends of cirrhosis and OHE were driven by males in both populations, and the 45-64 years age group in the commercial population and 65-74 years age group in the Medicare population.
By 2030, an estimated 1.22 million adults aged 18-64 years and 1.31 million adults aged ≥65 years will have cirrhosis, with 347,034 and 349,548 having OHE, respectively.
Conclusions: The prevalence of cirrhosis and OHE is projected to continue to increase in both commercial and Medicare populations, highlighting the need for increased disease awareness and strategies for management, such as developing therapies for reducing the risk of first OHE event, and improved access to treatments targeting OHE recurrence, to reduce the overall disease burden.

<b>Figure 1.</b> Observed and projected prevalence of cirrhosis in the commercial and Medicare populations in the United States, 2007–2030.

Figure 1. Observed and projected prevalence of cirrhosis in the commercial and Medicare populations in the United States, 2007–2030.

<b>Figure 2.</b> Observed and projected prevalence of OHE among patients with cirrhosis in the commercial and Medicare populations in the United States, 2007–2030.

Figure 2. Observed and projected prevalence of OHE among patients with cirrhosis in the commercial and Medicare populations in the United States, 2007–2030.

Aaron Samson

Appearances