Epidemiology of alcoholic liver disease

Abstract

Alcohol abuse is recognized as a major determinant of public health outcomes. The use of alcohol accounted for 5.9% of all deaths worldwide in 2012. Only in the twentieth century has alcohol been found to be a direct hepatotoxin. A dose dependent relationship has been described in many studies across many countries between the consumption of alcohol and the development of alcoholic liver disease. There is not a clear consumption threshold for development of liver disease, which spans a spectrum from steatosis to steatohepatitis to fibrosis to cirrhosis. Other factors for development of cirrhosis include type of alcohol, pattern of drinking, gender, age, ethnicity, obesity, viral hepatitis, genetics, smoking, coffee, and hepatic iron overload. Worldwide data from 2010 indicate greater than 1 million deaths (2% of all deaths) and 31 million disability adjusted life years (DALYs) lost were related to liver cirrhosis and alcohol contributed to 493,300 of those deaths (47.9%). Often alcoholic liver disease affects a relatively more productive middle-aged cohort relative to other liver diseases and this effect poses unique societal and economic costs. Regional variations in consumption and public policy have provided outcomes worthy of study and understanding the epidemiology of alcoholic liver disease is important to this end. In countries where the per capita consumption of alcohol decreases, there appears to be an associated drop in the burden of disease. Avoidance of alcohol remains the best treatment of alcoholic liver disease and the burden of this lethal disease is preventable.