The epidemiology of alcoholic liver disease

Abstract

This article describes the various forms of alcoholic liver disease (ALD), with particular emphasis on cirrhosis, the form of liver disease that often is most associated with alcohol abuse and about which the most information is available. Epidemiological research has evaluated the prevalence of ALD and the factors that often contribute to the disease. Although the most potent factor in ALD is the excessive consumption of alcoholic beverages, gender and ethnic differences also account for some important variations in rates of liver disease. Mortality rates from cirrhosis have declined in the United States and some other countries since the 1970s. A number of factors may have contributed to this decline, including increased participation in treatment for alcohol problems and Alcoholics Anonymous membership, decreases in alcohol consumption, and changes in the consumption of certain types of alcoholic beverages.

Figure 1

Alcohol consumption and incidence of cirrhosis of the liver in men (m) and women (w). Studies have shown a close relationship between alcohol consumption and cirrhosis risk. NOTE: Data truncated at 70 g/day.

Figure 2

Age-adjusted death rates of liver cirrhosis by gender, 1910–1932 in death registration States, and 1933–1977 in entire United States. U.S. cirrhosis mortality rates were high at the beginning of the 20th century, declined precipitously with the introduction of Prohibition, and increased again when Prohibition ended. Mortality rates continued to increase until the early to mid-1970s, when these rates began to approach the levels seen in the first decade of the century. In the mid-1970s cirrhosis mortality rates began to decline again, as they had with the introduction of Prohibition, and they have continued to decline. INSET (shaded area): Per capita alcohol consumption for the years 1935 to 1999, illustrating the link between alcohol consumption and cirrhosis mortality. SOURCES: Mortality rate data adapted from Yoon et al. 2001; consumption data from Nephew et al. 2002.

Figure 3

Age-adjusted rates of alcohol-related cirrhosis by gender and ethnic group (Black, White, and Hispanic), United States, 1970–1998. SOURCE: Yoon et al. 2001. (Categories shown in this figure were those used in the source study.)