Clinical impact of alcohol-related cirrhosis in the next decade: estimates based on current epidemiological trends in the United States

Abstract

Background: Identifying changes in the epidemiology of liver disease is critical for establishing healthcare priorities and allocating resources to develop therapies. The projected contribution of different etiologies toward development of cirrhosis in the United States was estimated based on current publications on epidemiological data and advances in therapy. Given the heterogeneity of published reports and the different perceptions that are not always reconcilable, a critical overview rather than a formal meta-analysis of the existing data and projections for the next decade was performed.

Methods: Data from the World Health Organization Global Status Report on Alcohol and Health of 2014, Scientific Registry of Transplant Recipients from 1999 to 2012, National Institute on Alcohol Abuse and Alcoholism, and the Centers for Disease Control and Prevention were inquired to determine future changes in the epidemiology of liver disease.

Results: Alcohol consumption has increased over the past 60 years. In 2010, transplant-related costs for liver recipients were the highest for hepatitis C (~$124 million) followed by alcohol-related cirrhosis (~$86 million). We anticipate a significant reduction in incidence cirrhosis due to causes other than alcohol because of the availability of high efficiency antiviral agents for hepatitis C, universal and effective vaccination for hepatitis B, relative stabilization of the obesity trends in the United States, and novel, potentially effective therapies for nonalcoholic steatohepatitis. The proportion of alcohol-related liver disease is therefore likely to increase in both the population as a whole and the liver transplant wait list.

Conclusions: Alcohol-related cirrhosis and alcohol-related liver disorders will be the major cause of liver disease in the coming decades. There is an urgent need to allocate resources aimed toward understanding the pathogenesis of the disease and its complications so that effective therapies can be developed.

Keywords: Alcohol; Cirrhosis; Healthcare Costs; Hepatitis C; Liver Disease.

Figure 1

Number of discharged patients from the US hospitals with alcohol related diagnosis: Hospital discharges in the United States related to cirrhosis show that over half are due to alcohol related cirrhosis. NIAAA Data report #99 (December 2014).

Figure 2

Panel A: Number of patient discharged from US hospitals who carried a diagnosis related to alcohol abuse: Patients discharged from hospitals in the United States with a diagnosis of alcohol disorder. Numbers are in the 1000's. Data derived from NIAAA Surveillance Report #99 (December 2014). Panel B: Projection on future numbers of discharged patients from US hospitals with Alcohol related diagnosis: Alcohol related diagnosis is predicted to continue increasing in the next 10 years as shown in the projection made from the current hospital discharges

Figure 2

Panel A: Number of patient discharged from US hospitals who carried a diagnosis related to alcohol abuse: Patients discharged from hospitals in the United States with a diagnosis of alcohol disorder. Numbers are in the 1000's. Data derived from NIAAA Surveillance Report #99 (December 2014). Panel B: Projection on future numbers of discharged patients from US hospitals with Alcohol related diagnosis: Alcohol related diagnosis is predicted to continue increasing in the next 10 years as shown in the projection made from the current hospital discharges

Figure 3

Panel A: Death rate in cirrhotic population: High yearly death rate from alcohol related cirrhosis compared with other specific and non-specific causes of cirrhosis. Data from NIAAA surveillance report # 100 (December 2014). Panel B: Projection using linear regression model on death in cirrhotic population rate till 2025: Projection made on the death rate in the cirrhotic population with different etiologies.

Figure 3

Panel A: Death rate in cirrhotic population: High yearly death rate from alcohol related cirrhosis compared with other specific and non-specific causes of cirrhosis. Data from NIAAA surveillance report # 100 (December 2014). Panel B: Projection using linear regression model on death in cirrhotic population rate till 2025: Projection made on the death rate in the cirrhotic population with different etiologies.

Figure 4

Per capita alcohol consumption from 1950 till 2010 and projection till 2025: Per capita alcohol consumption during the last 6 decades in the United States data was driven from NIAAA surveillance report # 98 (April 2014). Projection was made based on the past as well on the current rates of alcohol consumptions in the United States.

Figure 5

Panel A: The changing burden of hepatitis C virus infection in the United States: model-based predictions: The prevalence of HCV is decreasing in the United States because of improved HCV screening and availability of new antiviral agents (Kabiri et al. 2014). Panel B: The changing prevalence of HCV-associated decompensated cirrhosis and hepatocellular carcinoma in the United States: The prevalence of HCV-associated decompensated cirrhosis and hepatocellular carcinoma in the United States is expected to decrease due to the advances in management of HCV infection (Kabiri et al. 2014). Panel C: Anticipated numbers of HCV cirrhosis associated transplant till 2050. Due to the expected decrease in HCV prevalence, the number of patients with HCV cirrhosis undergoing liver transplantation will also decrease over time.

Figure 5

Panel A: The changing burden of hepatitis C virus infection in the United States: model-based predictions: The prevalence of HCV is decreasing in the United States because of improved HCV screening and availability of new antiviral agents (Kabiri et al. 2014). Panel B: The changing prevalence of HCV-associated decompensated cirrhosis and hepatocellular carcinoma in the United States: The prevalence of HCV-associated decompensated cirrhosis and hepatocellular carcinoma in the United States is expected to decrease due to the advances in management of HCV infection (Kabiri et al. 2014). Panel C: Anticipated numbers of HCV cirrhosis associated transplant till 2050. Due to the expected decrease in HCV prevalence, the number of patients with HCV cirrhosis undergoing liver transplantation will also decrease over time.

Figure 5

Panel A: The changing burden of hepatitis C virus infection in the United States: model-based predictions: The prevalence of HCV is decreasing in the United States because of improved HCV screening and availability of new antiviral agents (Kabiri et al. 2014). Panel B: The changing prevalence of HCV-associated decompensated cirrhosis and hepatocellular carcinoma in the United States: The prevalence of HCV-associated decompensated cirrhosis and hepatocellular carcinoma in the United States is expected to decrease due to the advances in management of HCV infection (Kabiri et al. 2014). Panel C: Anticipated numbers of HCV cirrhosis associated transplant till 2050. Due to the expected decrease in HCV prevalence, the number of patients with HCV cirrhosis undergoing liver transplantation will also decrease over time.

Figure 6

Projection using linear regression model on the numbers of alcohol related cirrhosis on the transplant list till 2025: An increase in the number of patients with alcohol related cirrhosis on the transplant waiting list and transplanted patients compared to other etiologies of cirrhosis is anticipated. Data from SRTR report 2014.

Figure 7

Panel A; Number of patients who underwent liver transplantation for cirrhosis due to different etiologies: Number of patients with alcohol related cirrhosis who underwent liver transplantation has been nearly unchanged during the past 4 years. Panel B: Percentage of listed to transplanted patients. Ratio of listed to transplanted patient numbers with a diagnosis of alcohol related cirrhosis is decreasing. Data from the SRTR report 2014.

Figure 7

Panel A; Number of patients who underwent liver transplantation for cirrhosis due to different etiologies: Number of patients with alcohol related cirrhosis who underwent liver transplantation has been nearly unchanged during the past 4 years. Panel B: Percentage of listed to transplanted patients. Ratio of listed to transplanted patient numbers with a diagnosis of alcohol related cirrhosis is decreasing. Data from the SRTR report 2014.

Figure 8

Prevalence of obesity and overweight people in the United States from 2000 to 2013. Prevalence of obesity has increased over the last 13 years but the rate of increase is lower since 2007. Data from the CDC behavioral risk factor surveillance report 2015.