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Disparities between research attention and burden in liver diseases: implications on uneven advances in pharmacological therapies in Europe and the USA
  1. Nambi Ndugga1,
  2. Teisha G Lightbourne2,
  3. Kavon Javaherian2,
  4. Joaquin Cabezas1,
  5. Neha Verma2,
  6. A Sidney Barritt IV1,
  7. Ramon Bataller1
  1. 1Divisions of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA
  2. 2Biochemistry, Departments of Medicine and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Ramon Bataller; bataller{at}med.unc.edu

Abstract

Objectives Effective oral therapies for hepatitis B and C have recently been developed, while there are no approved pharmacological therapies for alcoholic and non-alcoholic fatty liver diseases (ALD and NAFLD). We hypothesise that fewer advances in fatty liver diseases could be related to disparities in research attention.

Methods We developed the Attention-to-Burden Index (ABI) that compares the research activities during 2010–2014, and an estimate of disease burden of these 4 major liver diseases. The resulting ratio reflects either overattention (positive value) or inadequate attention (negative value) compared with disease burden. The mean research attention and disease burden were calculated from 5 and 6 different parameters, respectively. The efficacy rate of current pharmacological therapies was assessed from published clinical trials.

Findings The mean research attention for hepatitis B and C was 31% and 47%, respectively, while NAFLD and ALD received 17% and 5%. The overall burden was 5% and 28% for hepatitis B and C, and 17% and 50% for NAFLD and ALD. The calculated ABI for hepatitis B and C revealed a +6.7-fold and +1.7-fold overattention, respectively. NAFLD received an appropriate attention compared with its burden, while ALD received marked inadequate attention of −9.7-fold. The efficacy rate of current pharmacological agents was 72% for hepatitis B, 89% for hepatitis C, 25% for non-alcoholic steatohepatitis and 13% for alcoholic hepatitis. Importantly, we found a positive correlation between the mean attention and the efficacy rate of current therapies in these 4 major liver diseases.

Interpretation There are important disparities between research attention and disease burden among the major liver diseases. While viral hepatitis has received considerable attention, there is a marked inadequate attention to ALD. There is a critical need to increase awareness of ALD in the liver research community.

  • alcoholic liver disease
  • Hepatitis C virus
  • Hepatitis B virus
  • Non-alcoholic fatty liver disease
  • PUBLIC HEALTH

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Footnotes

  • Contributors NN participated in the collection and analysis of data on disease burden, efficacy of current pharmacological therapies, as well as in the interpretation of data, writing, critical revision and final approval of the manuscript. TGL participated in the collection of data from drug companies, ongoing clinical trials, as well as in the analysis of data and final approval of the manuscript. KJ participated in the collection of all data from major liver meetings (EASL and AASLD), analysis of data and final approval of the manuscript. JC participated in the statistical analysis, data presentation and interpretation, and the final approval of the manuscript. NV participated in the data collection and analysis of the published papers on each liver disease, and final approval of the manuscript. ASB participated in the conception and design of the work, and critical revision and final approval of the manuscript. RB participated in the conception and design of the work, data interpretation, drafting of the article and critical revision and final approval of the manuscript.

  • Funding This work was supported by a grant from NIAAA (1U01AA021908).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional data are available by emailing the corresponding author at bataller@med.unc.edu.

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