Cirrhosis of the liver in Brazil: mortality and productive years of life lost prematurely1

This descriptive study was done using official data on mortality from cirrhosis of the liver for the year 1989. Its objectives are: (a) to describe mortality from cirrhosis of the liver in Brazilian adults; (b) to estimate the productive years of life lost (PYLL) prematurely (between 20 and 59 years of age) from this cause; and (c) to show any regional differences in cirrhosis mortality or PYLL. The raw data were adjusted by age and sex, using the 1980 population of Brazil as the standard. Calculation of PYLL was based on the formula of Romeder and McWhinnie for years of potential life lost, modified by the author to express productive years of life lost. The crude death rates from cirrhosis were higher in the Southeast and North, and in all regions they were higher in males, the countrywide male/female ratio being 4.5. Cirrhosis mortality among males ranged from a low of 14.37 deaths per 100 000 in the Center-West to a high of 35.86 per 100 000 in the Southeast; for females the rates ranged from 3.49 deaths per 100 000 in the Center-West to 8.5 deaths per 100 000 in the North. The cirrhosis mortality curves by age for men showed a leveling off or decline after age 60, except in the North where the curve continued to rise. Like this latter curve, the cirrhosis mortality curves for women also kept rising progressively with increasing age, most markedly in the North and Northeast. Overall, mortality from cirrhosis of the liver accounted for 48.7% of the deaths from digestive system disorders among men and for 24.1% of such deaths among women. Of the 138 860 PYLL from cirrhosis of the liver in 1989, 83.2% were lost by males; but the average loss per person dying of cirrhosis nationwide, around 15.5 years, was similar for both sexes. Regionally, the average PYLL per affected person was higher for men and women in the North and for women in the Center-West than it was in the other regions. The data suggest that cirrhosis of the liver among men in all the regions, except the North, is probably attributable largely to alcoholism. Among males from the North, there is strong evidence that cirrhosis with a viral etiology (hepatitis B and C viruses) is also important. For women, the evidence suggests that cirrhosis of viral etiology predominates. ABSTRACT