{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:14:11Z","timestamp":1783430051145,"version":"3.54.6"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2010related mortality and disability across the MENA region, with a focus on variations by aetiology and Socio\u2010demographic Index (SDI). By identifying patterns and disparities in disease burden, the study seeks to support evidence\u2010based policymaking and optimise regional liver health planning efforts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed age\u2010standardised 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\u2010adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and the YLL\u2010to\u2010YLD ratio, applied as a novel epidemiologic indicator to illustrate evolving patterns in disease mortality versus chronicity. Aetiology\u2010specific trends were quantified using Estimated Annual Percentage Change (EAPC) and stratified by SDI to assess variability across countries and over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2021, cirrhosis burden varied markedly by SDI in the MENA region. Low\u2010SDI countries experienced the highest YLL\u2010to\u2010YLD ratio (122.2), reflecting a predominantly fatal disease course, whereas high\u2010middle and high\u2010SDI 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\u2010standardised DALY rate for cirrhosis decreased from 18498.2 in 1990\u20139749.3 in 2021, with the YLL\u2010to\u2010YLD ratio dropping from 123.6 to 71, signalling a transition toward less fatal and more manageable disease. Aetiology\u2010specific trends showed consistent decreases in YLL\u2010to\u2010YLD ratios across all causes: chronic hepatitis C (186.6\u2013108.5), chronic hepatitis B (180.4\u2013105.1), alcohol\u2010related cirrhosis (188.4\u2013116.1), and non\u2010alcoholic fatty liver disease (166.6\u201394.4). Cirrhosis from other causes remained the most disability\u2010predominant subtype (YLL\u2010to\u2010YLD ratio 25.6 in 2021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2010term care infrastructure, and reduce disparities across SDI levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70605","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:54:33Z","timestamp":1774594473000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changing Cirrhosis Burden in the\n                    <scp>MENA<\/scp>\n                    Region, 1990\u20132021: From Premature Mortality to Disability (Global Burden of Disease)"],"prefix":"10.1111","volume":"46","author":[{"given":"Razan","family":"Emad","sequence":"first","affiliation":[{"name":"Department of Medicine Jordan University Hospital  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siham","family":"AlSinani","sequence":"additional","affiliation":[{"name":"Department of Child Health Sultan Qaboos University Hospital, University Medical City  Muscat Oman"},{"name":"Department of Child Health Sultan Qaboos University Hospital, Sultan Qaboos University  Muscat Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3396-6894","authenticated-orcid":false,"given":"Mohamed","family":"El\u2010Kassas","sequence":"additional","affiliation":[{"name":"Endemic Medicine Department, Faculty of Medicine Helwan University  Cairo Egypt"},{"name":"Steatotic Liver Diseases Study Foundation in Middle East and North Africa (SLMENA)  Cairo Egypt"},{"name":"Applied Science Research Center, Applied Science Private University  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Eslam","sequence":"additional","affiliation":[{"name":"Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney  Westmead New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh A.","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Liver, Digestive, and Lifestyle Health Research Section, and Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center  Riyadh Saudi Arabia"},{"name":"Division of Gastroenterology and Hepatology Weil Cornell Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Steatotic Liver Diseases Study Foundation in Middle East and North Africa (SLMENA)  Cairo Egypt"},{"name":"Department of Gastroenterology School of Medicine, Recep Tayyip Erdo\u011fan University  Rize Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bashar","family":"Emad","sequence":"additional","affiliation":[{"name":"Department of Medicine Queen Alia Military Hospital, Jordanian Royal Medical Services  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3521-8523","authenticated-orcid":false,"given":"Khalid A.","family":"Alswat","sequence":"additional","affiliation":[{"name":"Steatotic Liver Diseases Study Foundation in Middle East and North Africa (SLMENA)  Cairo Egypt"},{"name":"Liver Disease Research Center, Department of Medicine College of Medicine, King Saud University  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer","family":"Alduri","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology and Hepatology The Medical City for Military and Security Services  Muscat Oman"},{"name":"Department of Community Medicine and Public Health Institute of Medicine, University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Gastroenterology and Hepatology University Hospital Ghent  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal M.","family":"Sanai","sequence":"additional","affiliation":[{"name":"Steatotic Liver Diseases Study Foundation in Middle East and North Africa (SLMENA)  Cairo Egypt"},{"name":"Gastroenterology Section, Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard \u2010 Health Affairs  Jeddah Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal","family":"Abaalkhail","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University  Riyadh Saudi Arabia"},{"name":"Department of Medicine, King Faisal Specialist Hospital and Research Center  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2892-266X","authenticated-orcid":false,"given":"Khalid M.","family":"AlNaamani","sequence":"additional","affiliation":[{"name":"Steatotic Liver Diseases Study Foundation in Middle East and North Africa (SLMENA)  Cairo Egypt"},{"name":"Department of Medicine, Division of Gastroenterology and Hepatology The Medical City for Military and Security Services  Muscat Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.5997"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-17948-6"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-018012"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1159\/000533946"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-20445-5"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2025.102104"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","unstructured":"J.Salomon \u201cDisability\u2010Adjusted life years \u201d(2014).","DOI":"10.1016\/B978-0-12-375678-7.00511-3"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002472"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000062"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.70001"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.03.017"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00757-8"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30349-8"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00367-2"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-021-00494-z"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/10732748241297346"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.12.001"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2024.2328521"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-025-02631-3"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2023.04.015"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41256-017-0044-9"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-09132-0"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30994-2"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.11.042"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13237411"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/14787210.2018.1448709"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.70032"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v24.i40.4606"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.5001\/omj.2022.54"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.13-0333"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15852"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.21037\/tgh-23-118"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.7570\/jomes23052"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.049387"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-023-00759-2"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/5582297"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30695"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-015-3592-1"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(22)00047-X"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30074"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sintl.2021.100117"},{"issue":"6","key":"e_1_2_10_44_1","first-page":"29","article-title":"Role of Health Awareness Campaigns in Improving Public Health: A Systematic Review","volume":"12","author":"Bugshan W.","year":"2022","journal-title":"Int J Life Sci Pharma Res [Internet]"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czx039"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1057\/jphp.2013.22"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70605","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.70605","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70605","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:16:48Z","timestamp":1783426608000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.70605"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":45,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/liv.70605"],"URL":"https:\/\/doi.org\/10.1111\/liv.70605","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]},"assertion":[{"value":"2025-10-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70605"}}