Alcohol-related liver disease affects millions of people in China. Modelling shows that the current level of high-risk alcohol consumption would lead to even higher numbers in the future. However, the model also shows that effective alcohol policy solutions could prevent almost 2 million cases of alcohol-related liver disease between 2022 and 2040.

Author

Meiyu Wu, Shuxia Qin, Chongqing Tan, Sini Li, Ouyang Xie & Xiaomin Wan

Citation

Wu, M., Qin, S., Tan, C. et al. Estimated projection of incidence and mortality of alcohol-related liver disease in China from 2022 to 2040: a modeling study. BMC Med 21, 277 (2023). https://doi.org/10.1186/s12916-023-02984-7

Source
BMC Medicine
Release date
27/07/2023

Estimated projection of incidence and mortality of alcohol-related liver disease in China from 2022 to 2040: a modeling study

Research article

Summary

China has one of the highest numbers of liver disease cases in the world, including 6.4 million cirrhosis associated with alcohol-related liver disease (ALD) cases. However, there is still a lack of urgent awareness about the growth of alcohol consumption and the increased burden of ALD in China.

The negative impact of the rising rate of high-risk alcohol use on public health is increasing in China.

With the current alcohol consumption trends, the results of the study showed that from 2022 to 2040, more than 3.6 million Chinese people would develop alcoholic cirrhosis, and there would be nearly 2 million deaths because of alcohol-related liver disease. 

3.6 Million
Trend towards high level of liver cirrhosis cases due to alcohol
With the current alcohol consumption trends, between 2022 to 2040, more than 3.6 million Chinese people would develop liver cirrhosis due to alcohol.

Alcohol-related liver disease (ALD) refers to a range of liver conditions, including fatty liver disease, alcoholic hepatitis, liver fibrosis, and cirrhosis with its complications. Alcohol-related cirrhosis may further progress to hepatocellular carcinoma. High-risk consumption of alcohol is the primary cause of ALD and its associated deaths. Patients with advanced ALD have a poor prognosis, with a median survival time of only 1–2 years. 

In 2017, alcohol-related cirrhosis affected 26.1 million people and caused 332,268 deaths worldwide.

The prevalence of alcohol-related cirrhosis in China was estimated at 328.4 per 100,000 population, which was lower than that in Russia (709.7 per 100,000 population) but higher than that in Japan (313.1 per 100,000 population) and Singapore (267 per 100,000 population). However, due to China’s large total population, the number of alcohol-related cirrhosis cases was as high as 6.4 million.

The researchers developed a model to simulate the development of ALD until 2040 in China. They estimated the incidence and mortality of alcohol-related cirrhosis and hepatocellular carcinoma between 2022 and 2040 under four projected scenarios: 

  • Status quo,
  • 2% annual decrease in high-risk alcohol consumption,
  • 4% annual decrease in high-risk alcohol consumption, and
  • 8% annual decrease in high-risk alcohol consumption.

If nothing is done to reduce alcohol use in China, there would be 3.61 million new cases of cirrhosis from 2022 to 2040, resulting in a cumulative 1.96 million deaths from alcohol-related cirrhosis and hepatocellular carcinoma.

2 Million
Deaths due alcohol-related cirrhosis and liver cancer
If alcohol consumption remained at current levels, there would be 3.61 million new cases of cirrhosis from 2022 to 2040, resulting in a cumulative 1.96 million deaths from alcohol-related cirrhosis and hepatocellular carcinoma.

The study shows that a 2% annual reduction in high-risk alcohol use rates could avert 0.3 million deaths associated with ALD.

Moreover, 1.36 million new cases of alcoholic cirrhosis and 0.5 million ALD-related deaths would be prevented if the rate of high-risk alcohol use decreased by 4% annually.

The burden of ALD was further alleviated when the rate of high-risk alcohol use decreased by 8% annually, preventing almost 2 million individuals from developing cirrhosis and 0.8 million patients from ALD-related death.

8%
Reducing alcohol use prevents liver cirrhosis
Decreasing the rate of high-risk alcohol use by 8% annually, would help preventing almost 2 million individuals from developing cirrhosis.

With the adoption of the WHO Global Alcohol Action Plan by the World Health Assembly in 2022, China has supported the commitment to reduce national per capita alcohol use by 20% until 2030.

Abstract

Background

China has one of the highest numbers of liver disease cases in the world, including 6.4 million cirrhosis associated with alcohol-related liver disease (ALD) cases. However, there is still a lack of urgent awareness about the growth of alcohol consumption and the increased burden of ALD in China. Therefore, the researchers aimed to project the potential impact of changes in alcohol consumption on the burden of ALD in China up to 2040 under different scenarios.

Methods

The researchers developed a Markov model to simulate the natural history of ALD until 2040 in China. They estimated the incidence and mortality of alcohol-related cirrhosis and hepatocellular carcinoma between 2022 and 2040 under four projected scenarios:

  • status quo scenario and
  • scenarios with a 2%, 4%, and 8% annual decrease in high-risk alcohol consumption, respectively.

Results

Under the status quo scenario, the cumulative new cases of cirrhosis from 2022 to 2040 was projected to be 3.61 million, resulting in a cumulative 1.96 million deaths from alcohol-related cirrhosis and hepatocellular carcinoma.

However, a 2% annual reduction in high-risk alcohol consumption was expected to avert 0.3 million deaths associated with ALD, and a 4% annual reduction was projected to prevent about 1.36 million new cases of cirrhosis and prevent 0.5 million ALD-related deaths.

Moreover, an 8% annual reduction would prevent about 2 million new cases of cirrhosis and 0.82 million deaths.

Conclusions

Without any substantial change in alcohol attitudes and policies to regulate high-risk alcohol use, the disease burden of alcohol-related liver disease in China will increase enormously. Strengthening the implementation of alcohol policy solutions is critical and urgent to reduce the impact of alcohol-related liver disease on the Chinese population.

Source Website: BMC Medicine