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Summary Background Adverse outcomes of cirrhosis remain a top priority. Aims We examined the distribution of cirrhosis causes, HCC incidence and mortality and related changes over time in a nationwide U.S. cohort. Methods A retrospective study of a national sample of commercially insured patients with cirrhosis from Optum's de‐identified Clinformatics® Data Mart Database (CDM). Results A 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). Conclusions HCC 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.
Tran et al. (Wed,) studied this question.