Chronic liver disease is a precursor to cirrhosis and ultimately end-stage liver disease (ESLD), reflecting irreversible damage to liver cells, structures, and functions of the liver. It is the fifth leading cause of death between the ages of 45 and 64 ( Minino & Murphy, 2012), leading to more than 33,000 death each year ( Hoyert & Xu, 2012). Chronic liver disease results in more than 350,000 hospitalizations and 750,000 physician office visits each year ( Sandler, 2002). Department of Health and Human Services, 2004).
It is one of the most expensive digestive diseases in terms of health care costs at a total cost of approximately $1.6 billion annually, including $222 million for indirect costs of work lost ( U.S.
In the United States (U.S.) an estimated 5.5 million Americans have chronic liver disease ( U.S.
