SummaryBackgroundAdverse outcomes of cirrhosis remain a top priority.AimsWe examined the distribution of cirrhosis causes, HCC incidence and mortality and related changes over time in a nationwide U.S. cohort.MethodsA retrospective study of a national sample of commercially insured patients with cirrhosis from Optum's de‐identified Clinformatics® Data Mart Database (CDM).ResultsA total of 628,743 cirrhosis cases were identified with 45% having NAFLD, 19.5% HCV, and 16.3% ALD. African Americans had the highest rate of decompensation (60.6%), while Asians had the highest rate of HCC (2.4%), both p < 0.001. African Americans more frequently had HCV (28.4%) while Hispanic/Latinos more frequently had NAFLD (49.2%, p < 0.001). Patients in the 2014–2021 cohort were significantly older (63.0 ± 12.8 vs. 57.0 ± 14.3), less frequently decompensated (54.5% vs. 58.3%) but more frequently had HCC (1.7% vs. 0.6%) and NAFLD (46.5% vs. 44.2%), all p < 0.001. The overall annual incidence of HCC was 0.76% (95% CI: 0.75–0.77) with a 5‐year cumulative incidence of 4.03% (95% CI: 3.98–4.09), with significant variation by sex, race/ethnicity, and cirrhosis aetiology. The overall median years of survival were 11.4 (95% CI: 11.3–11.5) with a 5‐year cumulative survival of 73.4% (95% CI: 73.3%–73.6%), also with significant disparities in similar subgroups (lowest in cryptogenic cirrhosis and worse in 2014–2021 vs. 2003–2013). The 2014–2021 period was independently associated with worse survival (aHR: 1.14, 95% CI: 1.08–1.20).ConclusionsHCC incidence and survival vary by aetiology among patients with cirrhosis, with cryptogenic cirrhosis having the lowest survival and lower survival in the more recent time period.

中文翻译：

---

2003-2021 年美国全国范围内真实患者肝硬化特征和生存率的更新

摘要背景肝硬化的不良后果仍然是重中之重。目的我们在美国全国队列中检查了肝硬化原因的分布、HCC 发病率和死亡率以及随时间的相关变化。方法对来自 Optum 去识别的商业保险肝硬化患者的全国样本进行回顾性研究Clinformatics® 数据集市数据库 (CDM)。结果 总共确定了 628,743 例肝硬化病例，其中 45% 患有 NAFLD，19.5% 患有 HCV，16.3% 患有 ALD。非裔美国人失代偿率最高（60.6%），而亚洲人肝癌发生率最高（2.4%），两者均p< 0.001。非裔美国人更常见 HCV（28.4%），而西班牙裔/拉丁裔更常见 NAFLD（49.2%，p< 0.001）。 2014-2021 年队列中的患者年龄明显较大（63.0 ± 12.8 vs. 57.0 ± 14.3），失代偿频率较低（54.5% vs. 58.3%），但更常见的是 HCC（1.7% vs. 0.6%）和 NAFLD（46.5%） vs. 44.2%），全部p< 0.001。 HCC 的总体年发病率为 0.76%（95% CI：0.75–0.77），5 年累积发病率为 4.03%（95% CI：3.98–4.09），因性别、种族/民族和肝硬化而存在显着差异病因学。总体中位生存年数为 11.4 年（95% CI：11.3–11.5），5 年累积生存率为 73.4%（95% CI：73.3%–73.6%），相似亚组之间也存在显着差异（隐源性亚组中最低） 2014-2021 年与 2003-2013 年相比，肝硬化或更严重）。 2014-2021 年期间与较差的生存率独立相关（aHR：1.14，95% CI：1.08-1.20）。 结论 肝硬化患者的 HCC 发病率和生存率因病因而异，隐源性肝硬化患者的生存率最低，越多的患者生存率越低。最近的时间段。