Mortality from liver diseases attributable to hepatitis B and C in the EU/EEA – descriptive analysis and estimation of 2015 baseline

Figures & data

Table 1. Number of deaths and age-standardised rates per 100,000 population from hepatocellular carcinoma, liver cirrhosis and chronic liver disease as defined by WHO core 10 indicator and chronic viral hepatitis B and C and alcoholic liver disease, by gender, 2015, the EU/EEA countries.

Country	HCC						Cirrhosis						Chronic liver disease						Chronic viral hepatitis						Alcoholic liver disease
	(ICD-10 codes C22.0)						(ICD-10 codes K74.3-K74.6)						(ICD-10 codes K72-K75)						(ICD-10 codes B18.0, B18.1, B18.2)						(ICD-10 codes K70)
	Total		Females		Males		Total		Females		Males		Total		Females		Males		Total		Females		Males		Total		Females		Males
	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate	deaths	rate
Austria	487	5.8	109	2.5	378	9.2	779	9.2	238	5.5	541	13.0	826	9.7	264	6.1	562	13.5	262	3.1	149	3.5	113	2.7	669	7.8	159	3.6	510	12.2
Belgium	400	3.7	88	1.6	312	5.8	611	5.6	226	4.1	385	7.1	770	7.1	296	5.4	474	8.8	34	0.3	14	0.3	20	0.4	735	6.7	238	4.3	497	9.2
Bulgaria	224	2.9	83	2.1	141	3.9	1356	18.0	288	7.3	1068	29.7	1748	23.2	381	9.7	1367	38.0	8	0.1	1	0.0	7	0.2	131	1.8	12	0.3	119	3.3
Croatia	188	4.4	42	1.8	146	7.2	435	10.0	126	5.5	309	15.1	464	10.7	138	6.0	326	16.0	60	1.4	14	0.6	46	2.3	498	11.5	94	4.2	404	19.7
Cyprus	9	1.3	3	0.9	6	1.7	30	4.3	5	1.5	25	7.1	36	5.2	7	2.1	29	8.2	4	0.6	1	0.3	3	0.8	13	1.8	4	1.0	9	2.5
Czech Republic	274	2.7	66	1.3	208	4.3	466	4.5	200	3.8	266	5.3	643	6.2	281	5.3	362	7.3	26	0.3	10	0.2	16	0.3	1398	13.5	378	7.1	1020	20.2
Denmark	206	3.7	49	1.8	157	5.5	53	10.0	23	0.8	30	1.0	123	2.2	51	1.9	72	2.5	15	0.3	5	0.2	10	0.4	567	10.3	159	5.8	408	14.7
Estonia	32	2.5	7	0.9	25	4.7	71	5.5	44	6.1	27	4.6	85	6.5	47	6.5	38	6.5	5	0.4	2	0.3	3	0.5	230	17.8	61	8.6	169	29.6
Finland	264	4.6	64	2.2	200	7.0	127	2.2	74	2.6	53	1.9	152	2.7	87	3.0	65	2.3	6	0.1	2	0.1	4	0.1	951	17.1	242	8.6	709	25.8
France	4342	6.7	681	2.0	3661	11.7	2721	4.2	883	2.7	1838	5.9	3460	5.4	1249	3.8	2211	7.1	502	0.8	233	0.7	269	0.9	4344	6.8	1080	3.3	3264	10.5
Germany	4438	4.9	1095	2.4	3343	7.5	5942	6.6	2348	5.2	3594	8.1	6719	7.5	2786	6.1	3933	8.9	855	1.0	374	0.8	481	1.1	7958	9.0	2233	5.0	5725	13.1
Greece	320	2.8	71	1.2	249	4.3	560	4.9	170	2.9	390	6.9	670	5.8	222	3.8	448	8.0	56	0.5	18	0.3	38	0.7	177	1.6	23	0.4	154	2.8
Hungary	163	1.7	36	0.7	127	3.0	349	3.6	174	3.3	175	4.0	418	4.3	206	3.9	212	4.8	185	1.8	99	1.8	86	1.9	2731	27.6	670	12.5	2061	45.9
Iceland	11	4.4	4	3.1	7	5.4	4	1.4	1	0.9	3	2.1	6	2.3	2	1.8	4	2.9	3	1.2	1	0.9	2	1.4	8	2.8	5	3.6	3	2.0
Ireland	112	3.3	25	1.5	87	4.9	89	2.6	39	2.3	50	2.8	119	3.4	56	3.3	63	3.5	21	0.5	5	0.3	16	0.7	178	4.6	58	2.9	120	6.1
Italy	4871	7.1	1373	3.9	3498	10.5	4752	7.0	2002	5.7	2750	8.3	5386	7.9	2331	6.6	3055	9.3	2637	3.8	1412	4.0	1225	3.7	961	1.5	176	0.5	785	2.5
Latvia	35	1.7	11	0.9	24	3.0	194	9.7	72	6.4	122	14.2	202	10.1	75	6.7	127	14.8	54	2.7	18	1.6	36	4.1	163	8.2	60	5.5	103	11.6
Liechtenstein	0	0.0	0	0.0	0	0.0	1	3.2	1	6.5		0.0	1	3.2	1	6.5		0.0		0.0		0.0	0	0.0		0.0		0.0		0.0
Lithuania	80	2.7	23	1.3	57	4.7	429	14.7	183	11.2	246	19.2	459	15.7	196	12.0	263	20.5	28	1.0	11	7.0	17	1.3	314	10.7	90	5.6	224	17.2
Luxembourg	17	3.9	4	1.8	13	5.8	27	5.8	9	3.8	18	7.8	33	7.1	13	5.6	20	8.5	3	0.5		0.0	3	1.0	30	6.2	12	5.1	18	7.2
Malta	15	3.5	4	1.9	11	5.1	6	1.4	2	1.0	4	1.8	7	1.6	2	1.0	5	2.2		0.0		0.0		0.0	13	3.0	3	1.4	10	4.5
Netherlands	279	1.7	55	0.7	224	2.7	393	2.4	163	2.0	230	2.7	566	3.5	253	3.2	313	3.7	34	0.2	8	0.1	26	0.3	442	2.7	139	1.7	303	3.6
Norway	85	1.9	22	1.0	63	2.7	55	1.2	27	1.2	28	1.2	102	2.3	55	2.5	47	2.0	12	0.3	4	0.2	8	0.3	138	3.0	37	1.6	101	4.3
Poland	477	1.4	168	0.9	309	2.0	1544	4.3	640	3.4	904	5.4	2116	6.0	890	4.8	1226	7.3	293	0.8	120	0.6	173	1.0	4311	11.6	1050	5.4	3261	18.6
Portugal	536	4.9	75	1.3	461	9.0	396	3.6	123	2.2	273	5.3	551	5.1	186	3.2	365	7.1	128	1.2	33	0.6	95	1.9	643	6.0	107	1.9	536	10.5
Romania	682	3.6	245	2.5	437	4.9	7482	39.2	2881	28.9	4601	50.6	8222	43.1	3161	31.8	5061	55.7	55	0.3	34	0.3	21	0.2	700	3.6	160	1.6	540	5.9
Slovakia	143	3.2	38	1.6	105	5.1	294	6.2	118	4.8	176	8.0	374	8.0	155	6.2	219	10.1	20	0.4	9	0.4	11	0.5	1162	22.6	270	10.2	892	36.8
Slovenia	133	6.6	31	3.0	102	10.5	15	0.8	12	1.2	3	0.3	17	0.9	14	0.1	3	0.3	1	0.0	1	0.0		0.0	414	19.8	100	9.4	314	30.9
Spain	2727	6.0	599	2.6	2128	9.5	3169	7.0	1021	4.4	2148	9.6	3726	8.2	1255	5.4	2471	11.0	790	1.7	356	1.5	434	1.9	1238	2.7	188	0.8	1050	4.7
Sweden	221	2.3	54	1.1	166	3.3	234	2.4	90	1.9	144	2.9	362	3.7	154	3.2	206	4.1	78	0.8	27	0.6	49	1.1	405	4.3	115	2.5	288	5.9
United Kingdom	2112	3.5	458	1.5	1654	5.4	1983	3.3	865	2.9	1118	3.7	2783	4.6	1286	4.3	1497	4.9	300	0.5	95	0.3	205	0.7	5575	9.2	1936	6.3	3639	12.1
EU/EEA	23,883	4.6	5583	2.1	18299	7.3	34,567	6.7	13,048	5.0	21,519	8.6	41146.0	8.0	16,100	6.1	25,044	10.0	6475	1.3	3056	1.2	3417	1.4	37,097	7.2	9859	3.7	27,236	10.9

Source: Eurostat.

Figure 1. Age-standardised mortality rates per 100,000 population from hepatocellular carcinoma (ICD-10 code C22.0) in the EU/EEA countries in 2015.

Figure 2. Age-standardised mortality rates per 100,000 population from chronic liver diseases (ICD-10 codes K72–K75) in the EU/EEA countries in 2015.

Figure 3. Age-standardised mortality rates per 100,000 population from cirrhosis (ICD-10 codes K74.3–K74.6) in the EU/EEA countries in 2015.

Figure 4. Age-standardised mortality rates per 100,000 population from chronic viral hepatitis B and C (ICD-10 codes B18.0, B18.1 and B18.2) in the EU/EEA countries in 2015.

Figure 5. Mortality from liver diseases in the EU/EEA in 2015 and the fraction attributable to hepatitis B and C.

Note: Total mortality was calculated by summing up the number of deaths from liver cancer (ICD-10 code C22) and ‘cirrhosis and other chronic liver diseases’ (a broader definition of chronic liver diseases than that of WHO, including ICD-10 codes B18–B18.9, I85–I85.9, I98.2, K70–K70.3, K71.7, K74–K74.9, K75.2, K75.4–K76.2, K76.4–K76.9 and K77.8) extracted from Eurostat for each EU/EEA country. Mortality attributable to HBV and HCV was estimated by adjusting mortality figures for each country with the country-specific aetiology fraction estimates for HBV and HCV available from GBD publications. Overall for the EU/EEA, 45% or cirrhosis and other chronic liver diseases deaths (n = 34,898) and 55% of liver cancer deaths (n = 29,029) could be attributable to HBV and HCV. Baseline mortality attributable to HBV and HCV is thus, 63,927.

Table 2. Mortality attributable to HBV and HCV in 2015 in the EU/EEA – number of death from Eurostat adjusted by aetiology fraction (AF) estimates from Global Burden of Disease (GBD).

	Cirrhosis and other chronic liver disease			Liver cancer			Total deaths	Total mortality attributable to HBV and HCV
	(B18–B18.9, I85-I85.9, I98.2, K70–K70.3, K71.7, K74–K74.9, K75.2, K75.4–K76.2, K76.4–K76.9 and K77.8)			(ICD-10 C22 ‘Malignant neoplasm of liver and intrahepatic bile duct’)
	Deaths	AF GBD^a	Mortality attributable to HBV and HCV (deaths × AF GBD*)	Deaths	AF GBD^b	Mortality attributable to HBV and HCV (deaths × AF GBD^b)
	(a)		(b)	(c)		(d)	(a + c)	(b + d)
Austria	1739	0.43	750	929	0.45	418	2668	1168
Belgium	1440	0.34	488	948	0.44	417	2388	905
Bulgaria	1775	0.45	795	677	0.48	325	2452	1120
Croatia	1002	0.41	409	495	0.36	178	1497	587
Cyprus	53	0.44	23	51	0.58	30	104	53
Czech Republic	1798	0.43	775	818	0.39	319	2616	1094
Denmark	585	0.42	246	441	0.44	194	1026	440
Estonia	290	0.42	121	103	0.33	34	393	155
Finland	1062	0.45	476	505	0.54	273	1567	749
France	7936	0.43	3396	8544	0.53	4528	16480	7924
Germany	15,120	0.42	6301	7870	0.41	3227	22,990	9528
Greece	888	0.45	401	1558	0.6	935	2446	1336
Hungary	3142	0.42	1331	862	0.4	345	4004	1676
Iceland	13	0.38	5	19	0.61	12	32	17
Ireland	305	0.38	116	295	0.55	162	600	278
Italy	9395	0.70	6530	9702	0.71	6888	19,097	13,418
Latvia	434	0.43	187	134	0.55	74	568	261
Liechtenstein	1	NA	NA	0		0	1	NA
Lithuania	808	0.42	340	210	0.35	74	1018	414
Luxembourg	65	0.38	24	43	0.53	23	108	47
Malta	6	0.46	3	25	0.63	16	31	19
Netherlands	888	0.42	372	956	0.55	526	1844	898
Norway	206	0.45	93	265	0.63	167	471	260
Poland	5529	0.42	2321	2031	0.47	955	7560	3276
Portugal	1213	0.41	498	1134	0.54	612	2347	1110
Romania	8777	0.40	3516	3061	0.38	1163	11,838	4679
Slovakia	1356	0.44	596	403	0.41	165	1759	761
Slovenia	423	0.44	186	250	0.4	100	673	286
Spain	5608	0.37	2074	5044	0.72	3632	10,652	5706
Sweden	687	0.24	163	688	0.56	385	1375	548
United Kingdom	5550	0.44	2422	5189	0.55	2854	10,739	5276
EU/EEA	78,094	0.45	34,898	53,250	0.55	29,029	131,344	63,927

NA: not applicable.

Note: ‘cirrhosis and chronic liver diseases’ and liver cancer as defined by GBD; number of death reported by each country to Eurostat were adjusted by aetiology fraction (AF) estimates published by GBD.

^aGlobal Burden of Disease Collaborative Network. Global Burden of Disease Study 2016 (GBD 2016) Results. Available from http://ghdx.healthdata.org/gbd-results-tool

^bGlobal Burden of Disease Liver Cancer Collaboration. The burden of primary liver cancer and underlying aetiologies from 1990 to 2015 at the global, regional, and national level: results from the Global Burden of Disease Study 2015. 2017. JAMA Oncology.

Table 3. Mortality rates per 100,000 population from hepatocellular carcinoma, cirrhosis and chronic liver diseases as defined by WHO core 10 indicator, and chronic viral hepatitis B and C in the EU/EEA during 2011–2015.

	2011	2012	2013	2014	2015	% change 2011–2015^a	Difference in number of cases	Poisson regression for trend, p value
Hepatocellular carcinoma (C22.0)	4.47	4.60	4.57	4.68	4.71	5.30%	1456	.935
Cirrhosis (K74.3–K74.6)	7.30	7.20	6.90	6.80	6.60	−9.50%	−2934	.83
Chronic hepatitis B and C (B18.0, B18.1 and B18.2)	1.26	1.31	1.28	1.25	1.29	2.30%	225	.999
Chronic liver disease (K72–K75)	8.40	8.30	8.00	7.90	7.80	−7.20%	−2479	.857

^a(2015 rate–2011 rate)/2011 rate; countries reporting in ICD-9 codes format (Greece) or in ICD-10 format with a three-digits precision (Bulgaria and Slovakia) at any time during the period, were not included.