Gender and Time Trend of Liver Cirrhosis Mortality and Its Estimated Avoidable Proportion in a Mountainous Province of Viet Nam from 2005 To 2018 Gender and Time Trend of

Long Cong Nguyen1, Nghia Van Luu2, Nhung Thi Kim Ta3 and Ngoan Tran Le4,5* 1Gastroenterology & Hepatology Center, Bach Mai Hospital, Hanoi, Viet Nam 2Lang Son Provincial Center for Diseases Control (CDC), Lang Son city, Viet Nam 3Department of Occupational Health, School of Preventive Medicine and Public Health, Hanoi Medical University, Viet Nam 4Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam 5Department of Public Health, School of Medicine, International University of Health and Welfare, Japan

these facts and figures, we have hypothesized that liver cirrhosis is a lifestyle-related health event and a possible avoidable disease.
Patients suffering from liver cirrhosis need frequent medical care and their quality of life is affected [14]. Patients with liver cirrhosis have significantly increased morbidity and mortality [15].
However, few studies have been performed to address this public health problem in Viet Nam to date. This study aimed to estimate mortality rates, time trends by sex, and to estimate an avoidable proportion of death due to cirrhosis in men in Lang son Province from 2005 to 2018.

Methods
The study was performed in Lang Son province, a mountain highland province in northern Viet Nam. The study population is bordering Guangxi province in China and other provinces in Viet Nam. It was a population-based mortality registration operated by the Lang Son Center for Diseases Control (CDC) that covered all 226 communes of 11 cities/districts of the province, with a population of 790,500 people in 2018 [16]. In Viet Nam, the national mortality registration systems have been started from 1992 that was following the guideline by the Ministry of Health to report the causes of death from all health facilities nationwide. From 1992 to date, Lang Son is one of all 63 cities/provinces of the country to actively conduct mortality registration based on the medical records available at 226 state commune health stations (CHS), 10 [16,17].
We accessed to Lang Son database of mortality during 2005-2018, missing data for 2009-2010, to derive variables of case's ID, age, sex, date, and cause of death, ICD-10 code. We found ICD-10 code K74 for Liver Cirrhosis and a total number of 2,612 cases for the present study. We also derived the average number of population by years and by communes for further estimate number of person-year for the final analysis. We calculated the mortality rates ratio with a 95% confidence interval (MRR, 95%CI) using regression analysis, adjusted for age groups of 10-year intervals

Results
Overall, a total of 2,612 deaths were registered among residents in Lang Son Province from 2005 to 2018. Table 1 shows the results of deaths were 2,321 in men and 291 in women. Men had a higher age-adjusted mortality rate (ASR-WHO 63.2 per 100,000) due to cirrhosis compared to women (ASR-WHO 7.3 per 100,000), giving man to women ratio: 8.7/1 (63.2/7.3). The estimated men to women ratio were sharply increased from 4.9/1 (49.

Discussion
We observed a divergence over time from 2005 to 2018 between men (statistically significant increase) and women (statistically significant decrease) in a community in the mountainous province of Lang Son in northern Viet Nam. When compared to women, the estimated avoidable proportion of death due to the disease was about 88.5% in men. There was serious premature death, as high as 88.5% for both genders (91.3% in men and 66.3% in women).
The findings suggested that Liver Cirrhosis is a preventable disease and performing primary prevention in the community to reduce premature death would be highly needed. and tobacco smoking in Vietnamese women aged 15+ (1.7%) in 2010 [18] and it was a similar observation in the 1990s [20]. The estimated prevalence of Hepatitis C virus infection was very low (0.5%) in rural areas [19]. There was also a very low prevalence

Source(s) of Support
There was no support.

Conflicting Interest
There are no conflicts of interest to disclose.

Acknowledgment
We are grateful to all staff of the Lang Son's Health facilities involved in data collection, supervision, monitoring, and data management. There were no other conflicts of interest. All authors had input into the final version of the paper.