The risk of death for hospitalized liver disease patients is more than twice as high in lower- or lower-middle-income countries compared to high-income nations, according to a study that analyzed data from 25 countries, including India. The study, published in The Lancet Gastroenterology & Hepatology journal, found that the higher risk in lower-income countries is largely due to limited access to diagnostic and therapeutic resources.
Liver disease occurs when a person’s liver experiences chronic inflammation, often due to obesity, excessive alcohol use, viral hepatitis, or a combination. Over time, this inflammation can lead to severe scarring in the liver, known as cirrhosis, which disrupts liver function and can ultimately cause liver failure.
Liver disease is one of the world’s leading causes of death, currently accounting for 2 million deaths each year, and projected to claim even more lives in the future, according to the researchers.
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“A working liver is so important for our health since the organ is connected to so many aspects of bodily function,” said Jasmohan Bajaj, a professor at the Virginia Commonwealth University School of Medicine, US. “Anything that impacts the liver can influence how other organs and systems in our bodies operate, including our immune system, cardiovascular system, brain, gut, and kidneys,” Bajaj said.
Bajaj and Ashok K Choudhury, a professor at the Institute for Liver and Biliary Sciences in New Delhi, and colleagues investigated how the risk of death from cirrhosis varies across countries and what underlying factors are behind such inequities.
“Most cirrhosis research is focused on the global North or specific regions of the world and don’t account for differences in public health resources. Our work is one of the only prospective studies to analyze imbalances in cirrhosis mortality from a global perspective,” said Bajaj, the lead author of the study.
The research team collected and analyzed medical data from nearly 4,000 patients with cirrhosis at 90 medical centers in 25 countries across six continents. Compared to patients treated in high-income countries, cirrhosis patients in lower-income countries were more than twice as likely to die at the hospital or within 30 days of discharge, according to the data.
“These results are very shocking and sobering. We did not anticipate such a wide disparity in cirrhosis mortality, but it shows that globally we are not on a level playing field when it comes to addressing advanced liver disease,” Bajaj said.
The study also highlighted global differences in medical resources that could be contributing to the divergence in mortality rates.
For example, the survey data showed that cirrhosis patients in lower-income countries were less likely to have access to or afford relevant diagnostics, medications, therapies, ICU care, and liver transplant while hospitalized.
Cirrhosis patients in lower-income countries were also more likely to be hospitalized at later stages of the disease and were more likely to have gastrointestinal bleeding, hepatitis B flare, or infection, all of which are preventable conditions if provided with proper care, the researchers said.
The findings could reflect a lack of outpatient care for patients, as well as of personal financial resources, they said.
“The important thing to realize is that patient care for cirrhosis should start before they even need to go to the hospital. Recognition, access, and affordability of treatment are three important factors that would ideally prevent a lot of hospitalizations from occurring in the first place Bajaj added.
