Excess mortality from cirrhosis by neighbourhood deprivation, aetiology, and clinical presentation: a Swedish register-based cohort study

Background Socioeconomic inequalities are a persistent determinant of health inequity, but their influence on excess mortality from cirrhosis in high-income countries with universal healthcare is not well characterised.We aimed to estimate cirrhosis-related excess mortality across neighbourhood deprivation levels in Sweden. MethodsWe conducted a nationwide, register-based cohort study, including all individuals aged 40 years or older residing in Sweden between 2012 and 2022.The open, underlying cohort was stratified by calendar year, sex, 5year age groups, and residential neighbourhood.Neighbourhood strata were collapsed into deprivation quintiles, as per the national distribution of inhabitants with a low disposable household income, with Q1 being the least and Q5 the most deprived.Incident cirrhosis cases within the age span 40-74 years were identified using validated diagnostic algorithms, and followed for up to 5 years.Excess mortality rate ratios (EMRRs) were estimated using Poisson regression within a relative survival framework.Findings Among 21,583 individuals with incident cirrhosis, 8814 deaths occurred during 65,170 person-years of follow-up.The EMRR for 5-year excess mortality in Q5 versus Q1 was 1.19 (95% CI 1.10-1.29).At the population level, the age-standardised number of excess deaths within 5 years of diagnosis was substantially higher in deprived areas; with 2018 as the year of diagnosis, there were 23 excess deaths per 100,000 inhabitants in Q5 versus 12 in Q1, representing a 95% higher excess mortality burden.Interpretation Even within a universal healthcare system, cirrhosis-related excess mortality substantially increases with level of neighbourhood deprivation.Prevention and more optimal post-diagnostic management targeted towards deprived neighbourhoods are urgently needed to reduce avoidable deaths.