OBJECTIVES: To assess the incidence of liver complications in a large, nationally representative health fund in Israel.

METHODS: The study utilized the computerized database of Maccabi healthcare services (payer-provider). All members without cirrhosis or cancer on January 1st 2000 (index date) were followed until death, disenrollment or January 2017. Incident cirrhosis, liver transplant and liver cancer were detected by documented diagnoses, procedures, and the national cancer registry.

RESULTS: The cohort included 1,129,969 subjects with a mean follow-up time of 15.15 years (SD=4.17). The overall incidence rate of diagnosed cirrhosis was 1.85 per 10,000 person year (PY), ranging between 0.29 under the age 40 till 6.87 over age 60. The incidence of liver cancer was 0.75 per 10,000 PY, ranging between 0.07 and 3.62 for age<40 and >60 respectively. The incidence of liver transplant was 0.12 per 10,000 PY. After excluding patients with viral hepatitis or significant alcohol consumption (4.1%), the incidence reduced to 1.05 for cirrhosis, 0.58 for liver cancer and 0.05 for liver transplant. The incidence of all liver complications was significantly associated with BMI; with cirrhosis reaching a peak incidence of 6.69 for BMI of 35 or above, vs. 4.49 for BMI 30-34 or 3.53 for BMI 25-29, among patients aged 60+. The observed mean survival times from cirrhosis till liver cancer or transplant were 15.4 and 16.1 years respectively in the overall population, as compared with 16.3 and 16.7 years after excluding patients with viral hepatitis or alcohol-abuse.

CONCLUSIONS: This population-based study demonstrates the burden of liver complications even in patients without viral hepatitis or alcohol disorders, likely caused by non-alcoholic fatty liver disease. Older patients with increased BMI had higher rates of cirrhosis. The next phase of this study will validate the burden of non-alcoholic fatty liver disease using large-scale text mining of ultrasound reports.