Akademik Veri Yönetim Sistemi
LIVER INTERNATIONAL, cilt.46, sa.5, 2026 (SCI-Expanded, Scopus)
Background Cirrhosis is a major contributor to disease burden in the Middle East and North Africa (MENA) region, with variations in outcomes across socioeconomic contexts and etiologies. The primary aim of this study was to assess the temporal trends in cirrhosis-related mortality and disability across the MENA region, with a focus on variations by aetiology and Socio-demographic Index (SDI). By identifying patterns and disparities in disease burden, the study seeks to support evidence-based policymaking and optimise regional liver health planning efforts.Methods We analysed age-standardised data from the Global Burden of Disease Study to evaluate cirrhosis burden in the MENA region by SDI level in 2021 and by etiologic subtype in 1990 and 2021. Burden metrics included disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and the YLL-to-YLD ratio, applied as a novel epidemiologic indicator to illustrate evolving patterns in disease mortality versus chronicity. Aetiology-specific trends were quantified using Estimated Annual Percentage Change (EAPC) and stratified by SDI to assess variability across countries and over time.Results In 2021, cirrhosis burden varied markedly by SDI in the MENA region. Low-SDI countries experienced the highest YLL-to-YLD ratio (122.2), reflecting a predominantly fatal disease course, whereas high-middle and high-SDI countries demonstrated lower ratios (51.3 and 56.1, respectively), indicating improved survival but with more patients living longer with disability. From 1990 to 2021, the total age-standardised DALY rate for cirrhosis decreased from 18498.2 in 1990-9749.3 in 2021, with the YLL-to-YLD ratio dropping from 123.6 to 71, signalling a transition toward less fatal and more manageable disease. Aetiology-specific trends showed consistent decreases in YLL-to-YLD ratios across all causes: chronic hepatitis C (186.6-108.5), chronic hepatitis B (180.4-105.1), alcohol-related cirrhosis (188.4-116.1), and non-alcoholic fatty liver disease (166.6-94.4). Cirrhosis from other causes remained the most disability-predominant subtype (YLL-to-YLD ratio 25.6 in 2021).Conclusions Cirrhosis in the MENA region is undergoing a transition from fatal disease to a chronically disabling condition. These changes reflect advances in detection, treatment, and survival, but also underscore the need for policy adaptation to improve awareness, prevention, early diagnosis, expand long-term care infrastructure, and reduce disparities across SDI levels.