Public Health Measures and Prevention of Alcohol-Associated Liver Disease

Abstract

Hazardous alcohol consumption causes approximately 4% of deaths globally, constituting one of the leading risk factors for the burden of the disease worldwide. Alcohol has several health consequences, such as alcohol-associated liver disease, hepatocellular carcinoma, nonliver neoplasms, physical injury, cardiac disease, and psychiatric disorders. Alcohol misuse significantly affects workforce productivity, with elevated direct and indirect economic costs. Due to the high impact of alcohol consumption on the population, public health has led to the development of a range of strategies to reduce its harmful effects. Regulatory public health policies (PHP) for alcohol can exist at the global, regional, international, national, or subnational levels. Effective strategies incorporate a multilevel, multicomponent approach, targeting multiple determinants of drinking and alcohol-related harms. The World Health Organization categorizes the PHP into eight categories: national plan to fight the harmful consequences of alcohol, national license and production and selling control, taxes control and pricing policies, limiting drinking age, restrictions on alcohol access, driving-related alcohol policies, control over advertising and promotion, and government monitoring systems. These policies are supported by evidence from different populations, demonstrating that determinants of alcohol use depend on several factors such as socioeconomic level, age, sex, ethnicity, production, availability, marketing, and others. Although most policies have a significant individual effect, a higher number of PHP are associated with a lower burden of disease due to alcohol. The excessive consequences of alcohol constitute a call for action, and clinicians should advocate for developing and implementing a new PHP on alcohol consumption.

Keywords: ACLF, Acute-on-Chronic Liver Failure; ALD, Alcohol-associated Liver Disease; AUC, Area Under the Curve; AUD, Alcohol Use Disorder; AUDIT, Alcohol Use Disorders Identification Test; AUDIT-C, Alcohol Use Disorders Identification Test Concise; AVT, Alcohol Volumetric Tax; BAC, Blood Alcohol Concentration; DALYs, Disability-adjusted life years; GDP, Gross domestic product; PHP, Public Health Policies; PNPLA3, Patatin-like Phospholipase Domain-containing 3; USA, United States; USD, United States Dollars; WHO, World Health Organization; alcohol use disorders; alcohol-associated hepatitis; cirrhosis; fatty liver disease; steatosis.

Figure 1

Different public health policies to decrease alcohol-attributable health consequences.

Figure 2

Development of alcohol-related public health policies worldwide in 2010 (A) and 2016 (B). Data were obtained and categorized from the WHO Global Status Reports on Alcohol in 2014 and 2018. Countries in gray did not have information available.

Figure 3

Algorithm for the use of AUDIT-C in clinical practice.