Work

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

Year: 2026

Type: article

Abstract: 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. Methods: We 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, 5-year 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. Funding: The Swedish Cancer Society (Cancerfonden), The Swedish Research Council for Health, Working life and Welfare (Forte), The Swedish Gastroenterology Fund (Mag-Tarmfonden), The Swedish Research Council (Vetenskapsrådet), The Swedish Society of Medicine, The Swedish Foundation for Transplant and Cancer Research, and Region Stockholm (via a CIMED and clinical researcher award).

Source: EClinicalMedicine

DOI: 10.1016/j.eclinm.2026.103830

Authors: Juan Vaz, Jeffrey V. Lazarus, Hannes Hagström, Ulf Strömberg