Global, regional, and national burden of cirrhosis and other chronic liver diseases due to alcohol use, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019
Research article
Abstract
Background
To date, no study has evaluated trends in the burden of alcohol-induced cirrhosis and other chronic liver diseases based on the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2019 study.
The researchers report in this study on the global burden of alcohol-induced cirrhosis and other chronic liver diseases in terms of age, sex, and sociodemographic index (SDI) from 1990 to 2019, based on analysis of GBD 2019 data.
Methods
The estimated annual percentage change (EAPC) was calculated to determine the trends in the age-standardized incidence and mortality rates and disability-adjusted life years (DALYs) for alcohol-induced cirrhosis and other chronic liver diseases.
Results
From 1990 to 2019, the global age-standardized incidence rate showed an upward trend, whereas the global age-standardized mortality rate and DALYs showed a downward trend. Low- and low-middle SDI regions had much higher age-standardized DALYs.
Eastern Europe saw the largest increases in the age-standardized mortality rate and DALYs.
Lithuania had the largest increase in mortalities caused by alcohol-induced cirrhosis and other chronic liver diseases.
The age-standardized mortality rates and DALYs were higher in men than in women.
Conclusion
From 1990 to 2019, the age-standardized incidence rate of alcohol-induced cirrhosis and other chronic liver diseases increased globally; however, both the age-standardized mortality rate and DALYs caused by alcohol-induced cirrhosis and other chronic liver diseases showed decreasing trends. Future studies should devise preventive strategies for low and low-middle SDI regions, Eastern Europe, Lithuania, and other high-risk regions.
Highlights, meaning, and conclusion
Alcohol-induced liver disease is the primary cause of for liver-related morbidity and mortality worldwide. The global prevalence of alcohol-induced compensated and decompensated cirrhosis in 2017 was 23.6 and 2.5 million, respectively.
Alcohol-induced liver cirrhosis accounts for 1% of deaths worldwide – a trend that is projected to increase in the coming years. Moreover, because treatments for viral hepatitis are being devised and continuously improved, alcohol-related liver disease is now becoming the major contributor to the global burden of liver disease.
Globally, the number of incidences of alcohol-induced cirrhosis and other chronic liver diseases increased from 238767.07 in 1990 to 436056.22 in 2019.
Based on these values, the number of incidences due to these diseases increased by 82.63% from 1990 to 2019.
In 2019, the number of incident cases of alcohol-induced cirrhosis and other chronic liver diseases was highest in the middle sociodemographic index (SDI) region and lowest in the low sociodemographic index (SDI) region. Between 1990 and 2019, the incident number of alcohol-induced cirrhosis and other chronic liver diseases in all SDI regions increased. Notably, the low SDI region had a tremendous increase in the number of alcohol-induced cirrhosis and other chronic liver diseases changes from 1990 to 2019.
In 2019, the number of alcohol-induced cirrhosis and other chronic liver diseases incident cases was highest in South Asia, East Asia, and Western Europe, while lowest in Oceania, Australasia, Southern sub-Saharan Africa.
In addition, countries with the highest number of incident cases of alcohol-induced cirrhosis and other chronic liver diseases in 2019 were
- China (69310.00),
- India (68961.06), and
- Mexico (24106.77).
The lowest number of incident cases of alcohol-induced cirrhosis and other chronic liver diseases were in the following countries
- Tokelau (0.02),
- Niue (0.04) and
- Cook Islands (0.16).
Significant growth in the age-standardized incidence of alcohol-induced cirrhosis and other chronic liver diseases from 1990 to 2019 was observed in countries in the low-middle SDI quintile.
The region with the most obvious growth in the incidence of alcohol-induced cirrhosis and other chronic liver diseases from 1990 to 2019 was Central Asia, whereas the region with the smallest increase in the incidence of these diseases was South Asia.
At the global level, the age-standardized incidence rate of alcohol-induced cirrhosis and other chronic liver diseases reported a rising trend in most countries from 1990 to 2019.
The largest decrease in the age-standardized incidence of these diseases was in the Republic of Korea, while the largest increase was observed in Kazakhstan.
Globally, the number of DALYs of alcohol-induced cirrhosis and other chronic liver diseases decreased from 7312093.40 in 1990 to 11186601.49 in 2019.
In 2019, the number of DALY cases of alcohol-induced cirrhosis and other chronic liver diseases was highest in the middle SDI region and lowest in the low SDI region. Between 1990 and 2019, the DALYs number of alcohol-induced cirrhosis and other chronic liver diseases in all SDI regions increased. Notably, the low-middle SDI region had a tremendous increase in the number of alcohol-induced cirrhosis and other chronic liver diseases changes from 1990 to 2019.
The main risk factors for alcohol-induced cirrhosis and other chronic liver diseases are related to the level and method of alcohol consumption. For example, the risks associated with consuming large amounts of alcohol at once are greater than those associated with consuming smaller amounts at once. A recent study in 195 countries conducted from 1990 to 2016 on alcohol consumption and the associated mortality risk reported that, except for ischemic heart disease, the permissible level of alcohol consumption limit is 0 units/week; that is, any level of alcohol consumption can increase the overall risk of mortality.
To detect and treat these diseases as early as possible, patients with heavy alcohol consumption should be screened at alcohol withdrawal clinics.
The general population should minimize their alcohol intake. Abstinence is the most important and fundamental strategy to treat alcohol-induced cirrhosis and other chronic liver diseases.”
Zhang, X., Zhang, X., Liu, M. et al. Global, regional, and national burden of cirrhosis and other chronic liver diseases due to alcohol use, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019. BMC Gastroenterol 22, 484 (2022). https://doi.org/10.1186/s12876-022-02518-0
The study results highlight the burden of alcohol-induced cirrhosis and other chronic liver diseases in different countries and regions worldwide. Globally, both the age-standardized mortality rate and DALYs caused by alcohol-induced cirrhosis and other chronic liver diseases showed decreasing trends from 1990 to 2019.
Future preventive strategies should focus on the male population, particularly in Eastern Europe, Lithuania, and the other high-risk regions.
Efforts should also be made to increase awareness and promote education, change unhealthy lifestyles, reduce alcohol intake, and detect and treat alcohol-induced cirrhosis and other chronic liver diseases as early as possible.