Epidemiology and Disease Burden of Alcohol Associated Liver Disease

Abstract

Consumption of alcohol in excess leads to substantial medical, economic, and societal burdens. Approximately 5.3% of all global deaths may be attributed to alcohol consumption. Moreover, the burden of alcohol associated liver disease (ALD) accounts for 5.1% of all disease and injury worldwide. Alcohol use disorder (AUD) affects men more than women globally with significant years of life loss to disability in low, middle and well-developed countries. Precise data on global estimates of alcohol related steatosis, alcohol related hepatitis, and alcohol related cirrhosis have been challenging to obtain. In the United States (US), alcohol related steatosis has been estimated at 4.3% based on NHANES data which has remained stable over 14 years. However, alcohol-related fibrotic liver disease has increased over the same period. In those with AUD, the prevalence of alcohol related hepatitis has been estimated at 10-35%. Globally, the prevalence of alcohol-associated cirrhosis has been estimated at 23.6 million individuals for compensated cirrhosis and 2.46 million for those with decompensated cirrhosis. The contribution of ALD to global mortality and disease burden of liver related deaths is substantial. In 2016 liver disease related to AUD contributed to 50% of the estimated liver disease deaths for age groups 15 years and above. Data from the US report high cost burdens associated with those admitted with alcohol-related liver complications. Finally, the recent COVID-19 pandemic has been associated with marked increase in alcohol consumption worldwide and will likely increase the burden of ALD.

Keywords: AAPC, Average annual percentage change; ABIC, Age, Serum bilirubin, INR and serum Creatinine; ABV, Alcohol by volume; ALD, Alcohol-associated liver disease; AUD, Alcohol use disorder; BAC, Blood alcohol concentration; CDC, Centers for Disease Control and Prevention; COVID-19, Coronavirus disease 2019; GAHS, Glasgow alcoholic hepatitis score; HE, Hepatic encephalopathy; HRS, Hepatorenal syndrome; ICD-10, International Classification of Diseases, 10th Edition; MDF, Maddrey's Discriminant Function; MELD, Model of end-stage liver disease; MRI, Magnetic resonance imaging; NHANES, National Health and Nutrition Examination Survey; NIAAA, National Institute of Alcohol Abuse and Alcoholism; NIS, National inpatient sample; NSDUH, Annual National Survey on Drug Use and Health; SAMHSA, Substance Abuse and Mental Health Services Administration; US, United States; USG, Ultrasonography; WHO, World Health Organization; YLD, Years of life lost to disability; alcohol; alcohol use disorder; alcoholic cirrhosis; alcoholic hepatitis; alcoholic steatosis.

Figure 1

Implications of COVID 19 on alcohol related liver disease.

Figure 2

Stages and progression based on amount of alcohol consumption.