# Cirrhosis without a name

For the same age structure, people in Romania die of chronic liver disease 3.3 times as often as in the rest of the European Union, the highest rate in the EU. In 2023, 7,850 people in Romania died this way: 12% of all such deaths in the Union, in a country with 4% of the EU's population.

In cause-of-death statistics, the cause of cirrhosis is rarely coded. Of Romania's deaths coded as fibrosis and cirrhosis or as alcoholic liver disease, only 14% are coded as alcoholic; in the rest of the EU, 56%, and in Hungary, 88%. Almost all the others appear as “other and unspecified cirrhosis of liver”. Only Bulgaria has a lower share than Romania.

## What the certificate says

Cirrhosis has several possible causes: alcohol, viral hepatitis, fatty liver, autoimmune disease. The International Classification of Diseases has separate codes for alcoholic cirrhosis and for chronic hepatitis; cirrhosis from fatty liver or of unknown cause has no code of its own. On the death certificate, one condition becomes the underlying cause of death, and that is what enters the statistics.

In Romania, almost all deaths coded K74 are “other and unspecified cirrhosis of liver” (K74.6): 96%, in 2021–2023. Alcoholic liver disease appears 3,388 times, code K74.6 20,488 times. In Hungary, Poland, Slovakia and Croatia, countries with high liver death rates, most such deaths are coded as alcoholic. Bulgaria looks like Romania.

Other alcohol-related codes are rarer too. Deaths coded as alcoholic liver disease, alcohol-use disorders or alcohol poisoning are 8.1 per 100,000 people a year in Romania and 12.3 in the rest of the EU. Chronic hepatitis B and C, as the underlying cause, also appear less often (0.24 against 0.63 per 1,000 deaths).

The data do not say what should have been written. Code K74.6 can hide cirrhosis from alcohol, from hepatitis or from fatty liver; cirrhosis from hepatitis should be coded as hepatitis only if the certificate links the two. What the data show is that in Romanian statistics the cause of most cirrhosis deaths does not appear.

## How many die

The rates below are age-standardised, so that a country with more old people does not look worse than it is. In 2021–2023, Romania has the highest rate in the EU, 43.8 per 100,000; next come Estonia (34.3) and Slovakia (31.9). The rest of the EU, taken together, has a rate of 13.3. The ratio was between 3.1 and 3.7 every year from 2011 to 2023, falling since 2018.

The gap is almost as large for men (3.4 times) as for women (3.2 times) and starts early: between 45 and 64, Romania's rate is 3.5–3.8 times the rest of the EU's.

## Your county

INS does not publish liver deaths by county, only deaths from digestive diseases, of which chronic liver disease is 57% nationally. These are crude digestive-disease death rates, by usual residence, pooled over 2016–2025. National average: 77 per 100,000 a year. The rates are crude, not adjusted for residents' ages, and the county order is not an order of liver disease.

| County | Deaths | Per 100,000 a year (crude) | 95% interval | Against the national average (crude) |
|---|---|---|---|---|
| Bacău | 7,729 | 130.6 | 127.7–133.6 | above |
| Neamț | 5,085 | 113.9 | 110.8–117.1 | above |
| Galați | 5,711 | 113.6 | 110.7–116.6 | above |
| Vaslui | 4,136 | 110.4 | 107.0–113.8 | above |
| Buzău | 4,229 | 103.1 | 100.0–106.2 | above |
| Vrancea | 3,364 | 103.0 | 99.5–106.5 | above |
| Tulcea | 1,941 | 100.1 | 95.7–104.7 | above |
| Prahova | 7,082 | 99.8 | 97.5–102.2 | above |
| Teleorman | 3,239 | 98.1 | 94.7–101.5 | above |
| Maramureș | 4,296 | 93.8 | 91.1–96.7 | above |
| Botoșani | 3,608 | 93.5 | 90.4–96.6 | above |
| Brăila | 2,618 | 91.6 | 88.2–95.2 | above |
| Giurgiu | 2,378 | 89.8 | 86.3–93.5 | above |
| Satu Mare | 2,925 | 88.0 | 84.8–91.2 | above |
| Ialomița | 2,200 | 86.3 | 82.7–90.0 | above |
| Olt | 3,358 | 86.0 | 83.1–89.0 | above |
| Dolj | 5,173 | 83.9 | 81.6–86.2 | above |
| Dâmbovița | 3,921 | 80.4 | 77.9–83.0 | above |
| Călărași | 2,245 | 79.1 | 75.8–82.4 | – |
| Constanța | 5,278 | 79.1 | 76.9–81.2 | – |
| Mehedinți | 1,879 | 78.7 | 75.2–82.3 | – |
| Gorj | 2,443 | 77.6 | 74.5–80.7 | – |
| Iași | 5,939 | 75.6 | 73.7–77.5 | – |
| Hunedoara | 2,825 | 75.5 | 72.7–78.3 | – |
| Sălaj | 1,594 | 75.1 | 71.5–78.9 | – |
| Arad | 3,075 | 74.0 | 71.4–76.7 | below |
| Argeș | 4,197 | 72.9 | 70.7–75.2 | below |
| Vâlcea | 2,369 | 68.1 | 65.4–70.9 | below |
| Brașov | 3,700 | 66.9 | 64.8–69.1 | below |
| Bihor | 3,741 | 66.8 | 64.7–69.0 | below |
| Covasna | 1,327 | 65.8 | 62.3–69.4 | below |
| Mureș | 3,401 | 64.2 | 62.0–66.4 | below |
| Harghita | 1,904 | 63.7 | 60.9–66.7 | below |
| Alba | 1,979 | 60.6 | 58.0–63.3 | below |
| Bucharest | 10,684 | 59.8 | 58.6–60.9 | below |
| Cluj | 4,010 | 57.3 | 55.5–59.1 | below |
| Caraș-Severin | 1,470 | 56.1 | 53.2–59.0 | below |
| Sibiu | 2,221 | 55.9 | 53.6–58.3 | below |
| Suceava | 3,455 | 54.5 | 52.7–56.4 | below |
| Timiș | 3,159 | 46.1 | 44.5–47.7 | below |
| Ilfov | 2,356 | 45.7 | 43.9–47.6 | below |
| Bistrița-Năsăud | 1,236 | 43.2 | 40.8–45.6 | below |

## What these data do not show

- The data do not show the real cause of the unspecified cirrhoses: it may be alcohol, hepatitis, fatty liver or something else. The page assumes none.
- Countries fill in certificates differently; part of the gap in labels comes from habits of completion, not different diseases.
- World Health Organization data cover the last three years each country reported up to 2023 (for Romania 2021–2023); Germany has only 2018–2020, and Portugal and Croatia have non-consecutive years. Cyprus is missing; Finland and Slovenia report only three-character codes. On a common 2020–2022 window for all countries, the result is almost the same (12% against 56%).
- County rates are crude and include all digestive diseases, not only the liver.

## How the analysis was done

- Labels: World Health Organization mortality database, detailed ICD-10 codes, the last three years each country reported up to 2023. The “alcoholic” share = K70 deaths divided by K70 + K74 deaths. Only countries with at least 200 such deaths.
- Alcohol-related codes: deaths coded F10 (alcohol-use disorders), K70 and X45 (accidental alcohol poisoning), per 100,000 people a year, same years, with Eurostat population.
- Rates: Eurostat, hlth_cd_aro, “chronic liver disease” (K70, K73, K74), by age, with population from demo_pjangroup; direct standardisation to the 2013 European Standard Population, 2021–2023 pooled. “Rest of the EU” = the other 26 countries.
- Thresholds set before calculating: the headline uses the standardised ratio only if it is at least 2 (it was 3.3); a headline claim about the rate of alcohol-coded deaths is made only if the ratio is below 0.5; it was not met (the ratio was 0.66), so the value is only reported.
- Counties: INS TEMPO, deaths of usual residents by cause and county (POP206I, “diseases of the digestive system”) and resident population (POP105A), 2016–2025 pooled; exact 95% Poisson interval. The share of chronic liver disease in digestive deaths is computed from WHO data for Romania, 2021–2023, and is not known by county.

## Questions

### Does this mean Romania's cirrhosis comes from alcohol?

The data do not say that. They say only that in Romania and Bulgaria the cause of cirrhosis is rarely coded, while in many other countries it is.

### Why does it matter which cause is coded?

Deaths coded as “unspecified cirrhosis” appear in liver disease statistics, but cannot be attributed, from the statistics, to alcohol or to hepatitis.

### Why are counties so different?

The rates are crude and cover all digestive diseases. They can reflect residents' ages as well as how certificates are filled in in each county.

## Sources

- World Health Organization, Mortality Database (detailed ICD-10 files, February 2026 release).
- Eurostat, Causes of death by age group and sex, residents (hlth_cd_aro), chronic liver disease, 2011–2023; population by age group.
- Romania's National Institute of Statistics, TEMPO: POP206I (deaths by cause and county), POP105A (resident population).
- World Health Organization, International Classification of Diseases, ICD-10, block K70–K77.
- Eurostat, Revision of the European Standard Population (2013).