Contribution of alcohol use to the global burden of cirrhosis and liver cancer from 1990 to 2019 and projections to 2044

Abstract

Background: Identifying the temporal trends of cirrhosis and liver cancer attributable to alcohol use in both the past and the future can formulate the control strategies.

Methods: Data on cirrhosis and liver cancer attributable to alcohol use from 1990 to 2019, including mortality and disability-adjusted life year (DALY) rates were collected from the 2019 Global Burden of Disease (GBD) study. To analyze the temporal trends, the average annual percentage change (AAPC) was calculated, and the Bayesian age-period-cohort model was applied.

Result: Deaths and DALY of cirrhosis and liver cancer attributable to alcohol use increased year by years, but the age-standardized death rate (ASDR) and age-standardized DALY rate declined or remained stable from 1990 to 2019 in most regions of the world. The burden of cirrhosis attributable to alcohol increased in low-middle social-development index (SDI) regions, while the burden of liver cancer increased in high-SDI regions. Eastern Europe and Central Asia have the highest burden of cirrhosis and liver cancer caused by alcohol use. Deaths and DALYs are mainly distributed in people aged 40+ years, but there is an increasing trend in people aged under 40 years. New deaths from cirrhosis and liver cancer attributable to alcohol use are predicted to increase in the next 25 years, but the ASDR of cirrhosis in males will increase slightly.

Conclusions: Although the age-standardized rate of cirrhosis and liver cancer due to alcohol use have decreased, the absolute burden increased and will continue to increase. Therefore, alcohol control measures should be further strengthened and improved through effective national policies.

Keywords: Age-standardized rate; Alcohol use; Cirrhosis; Disability-adjusted life-years; Epidemiology; Global burden of disease; Liver cancer; Liver disease; Public health; Socioeconomics.

Fig. 1

The AAPC of ASR burden for cirrhosis and liver cancer attributable to alcohol use from 1990 to 2019 in global, SDI regions, and 21 GBD regions by sex. A AAPC of ASDR in cirrhosis; B AAPC of age-standardized DALY rate in cirrhosis; C AAPC of ASDR in liver cancer; D AAPC of age-standardized DALY rate in liver cancer. AAPC average annual percentage change, ASR age-standardized rate; GBD Global Burden of Diseases, Injuries, and Risk Factors Study; SDI socio-demographic index; ASDR age-standardized death rate

Fig. 2

The global disease burden of cirrhosis and liver cancer attributable to alcohol consumption for both genders in 204 countries and territories from 1990 to 2019. A AAPC of ASDR for cirrhosis; B AAPC of age-standardized DALY rate for cirrhosis; C AAPC of ASDR for liver cancer D AAPC of age-standardized DALY rate for liver cancer. AAPC average annual percentage change; DALYs disability-adjusted life-years; ASDR age-standardized death rate

Fig. 3

The burden of cirrhosis and liver cancer attributable to alcohol use for both genders in global by age group from 1990 to 2019. A Global number of death cases and death rate of cirrhosis; B Global number of DALYs and DALY rate of cirrhosis; C Global number of death cases and death rate of liver cancer; D Global number of DALYs and DALY rate of liver cancer. Each lines represent death/DALY rates for age group, and each bars represent the number of deaths/DALYs. DALYs disability-adjusted life-years

Fig. 4

The death and DALY rate of cirrhosis and liver cancer attributable to alcohol use in global, SDI regions, and 21 GBD regions in 2019 by age group and sex. A The death rate of cirrhosis attributable to alcohol use; B The DALY rate of cirrhosis attributable to alcohol use; C The death rate of liver cancer attributable to alcohol use; D The DALY rate of liver cancer attributable to alcohol use. The first column represents the 15–39 age group; the second column represents the 40–64 age group; the third column represents the 65 + age group. SDI socio-demographic index; GBD Global Burden of Diseases, Injuries, and Risk Factors Study; DALYs disability-adjusted life-years

Fig. 5

The observed (dashed line) and predicted (solid line) deaths of cirrhosis (A) and liver cancer (B) attributable to alcohol consumption from 1990 to 2044. The upper bound of Shading represents the rate increased by 1% per year (pessimistic reference) and the lower bound represents decreased by 1% per year (optimistic reference) based on the rate observed in 2019

Fig. 6

The relationship between SDI in 2019 and ASR and AAPC of cirrhosis and liver cancer attributable to alcohol use in 2019. A The correlation between AAPC of ASDR for cirrhosis and SDI; B The correlation between ASDR for cirrhosis in 2019 and SDI; C The correlation between AAPC of age-standardized DALY rate for cirrhosis and SDI; D The correlation between age-standardized DALY rate for cirrhosis in 2019 and SDI; E The correlation between AAPC of ASDR for liver cancer and SDI; F The correlation between ASDR for liver cancer in 2019 and SDI; G The correlation between AAPC of age-standardized DALY rate for liver cancer and SDI; H The correlation between age-standardized DALY rate for liver cancer in 2019 and SDI. Each point represents a country or a region that were available on SDI data, and the size of the point represents the number of cirrhosis or liver cancer deaths attributable to alcohol use. The cor indices Pearson’s correlation coefficient and P values were derived from Pearson’s correlation analysis. AAPC average annual percentage change; ASR age-standardized rate; SDI socio-demographic index; ASDR age-standardized death rate