Liver cirrhosis found to be more common in low-income households

Liver cirrhosis is significantly more common in low-income households than in high-income households. This is the result of a national study which, according to the researchers, calls for more preventive action in the most vulnerable groups.

Earlier this year, a study was presented revealing that the risk of dying from the most common form of primary liver cancer, hepatocellular carcinoma (HCC), is about 30% higher in low-income households compared to middle- or high-income households.

In the current study, the researchers focus instead on liver cirrhosis, which is the most common risk factor for HCC. In lcirrhosis, the liver is damaged, but the patient may remain asymptomatic and retain liver function for many years, until the disease progresses to more severe stages.

In Sweden, about half of the cases are linked to long-term overconsumption of alcohol. Other common causes of liver cirrhosis are chronic viral hepatitis and steatotic liver disease, often linked to diabetes or obesity.

Multi-fold increased risk

The study published in The Lancet Public Health is register-based and includes all individuals aged 15 and over who were resident in Sweden between 2001 and 2022. The database identified 49,550 cases of liver cirrhosis. The study is the largest of its kind in Sweden to map the link between socioeconomics and liver cirrhosis.

The incidence of alcohol-related liver cirrhosis was found to be three times higher in the lowest income households compared to the highest income households. In liver cirrhosis linked to steatotic liver disease, the incidence was almost twice as high. The biggest difference was seen for viral cirrhosis (hepatitis B and C), where the incidence was more than nine times higher among people in low-income households.

The results should be interpreted while considering that liver cirrhosis causes widespread morbidity and mortality, resulting in significant patient suffering and societal costs. It is also a disease that is on the rise in the wake of alcohol overconsumption and metabolic disease.

Need for targeted interventions

The study was conducted by Juan Vaz, a researcher from the School of Public Health and Community Medicine at Sahlgrenska Academy, University of Gothenburg, who is also an affiliated researcher to Karolinska Institutet and work as a hepatologist at the Transplant Center at Sahlgrenska University Hospital:

The incidence of liver cirrhosis is increasing in Sweden and is unevenly distributed across income groups, a finding that is likely to be replicated in other high-income countries. What is needed is targeted prevention and earlier detection of the disease, especially among socioeconomically disadvantaged groups.”

Juan Vaz, researcher, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg

“A major challenge is that liver cirrhosis often is not symptomatic until the disease is well advanced. Primary care is already doing quite a lot, but it is difficult to detect these patients in time. To be more successful, we need simpler tools, such as risk algorithms and biomarkers, to help doctors identify those patients most in need of early evaluation,” concludes Juan Vaz.