A study published in the Journal of Clinical Gastroenterology finds that cirrhosis of the liver is more common in the US than previously thought.

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Many people do not have symptoms of liver cirrhosis; in the early stages, it is often first detected through a routine blood test or check up.

Cirrhosis is where – through continuous, long-term damage – the liver becomes so scarred it cannot function properly. The disease can lead to liver failure and cancer.

In the US, liver cirrhosis is the twelfth leading cause of death overall and the fifth leading cause of death for people aged between 45 and 54.

Symptoms include jaundice, fatigue, bleeding, bruising easily, swelling, confusion and nausea. Many people do not have symptoms of liver cirrhosis; in the early stages, it is often first detected through a routine blood test or check up.

Led by the Loyola University Chicago Stritch School of Medicine, the study uses data from the National Health and Nutrition Examination Survey (NHANES) for the first time to estimate the prevalence of liver cirrhosis in the general US population. NHANES is an annual US population representative survey carried out by the Centers for Disease Control and Prevention (CDC).

The researchers found that cirrhosis of the liver affects over 633,000 adults in the US population and not 400,000 as previously thought. And they suggest 69% of Americans with liver cirrhosis do not realize they have the disease.

First author Steven Scaglione, an assistant professor in the departments of Medicine and Public Health Sciences at Loyola, says:

Although some of these individuals may simply have forgotten or been confused about the question, this raises the possibility of a large number of undiagnosed cases of cirrhosis.”

The team found that in over 50% of cases of liver cirrhosis, the most significant contributing factors were alcohol abuse, diabetes and hepatitis C – all three of which are preventable, notes Prof. Scaglione.

The team’s analysis of the NHANES data finds that the prevalence of cirrhosis is around 0.27%, which translates to 633,323 adults in the US. This is significantly higher than the 400,000 best-guess estimates of the number of American adults with the disease, says the team.

The study also finds that people with liver cirrhosis had a mortality rate of 26.4% over a 2-year period, compared with 8.4% among matched adults without the disease.

Compared with the general population, it appears that cirrhosis tends to affect people who are older, male, less educated, less well off and less likely to be living with a partner, say the researchers.

The results also showed that around 25% of people with cirrhosis said they had drunk alcohol in excess during the year before they were surveyed and nearly 50% had tested positive for hepatitis C.

In reaching their conclusions, the authors acknowledge one of the study’s limitations is the possibility it may have counted people with mild liver disease in the numbers of those estimated to have cirrhosis of the liver. This is because they used a technique called aspartate aminotransferase-to-platelet ratio, or APRI, which has not been validated in the general population as a way to qualify people with liver cirrhosis.

On the other hand, it is possible that the true prevalence of cirrhosis in the US is actually higher than the study’s estimate because the data used excludes military veterans, prisoners and immigrants.

In April 2014, Medical News Today brought news of a study that showed how an interferon-free therapy for hepatitis C cured 90% of patients with liver cirrhosis in only 12 weeks and was found to be safe in patients who could not have interferon.