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Abstract
Heavy alcohol consumption is a major cause of morbidity and mortality. Globally, alcohol per-capita consumption rose from 5.5 litres in 2005 to 6.4 litres in 2016 and is projected to increase further to 7.6 litres in 2030. In 2019, an estimated 25% of global cirrhosis deaths were associated with alcohol. The global estimated age-standardized death rate (ASDR) of alcohol-associated cirrhosis was 4.5 per 100,000 population, with the highest and lowest ASDR in Africa and the Western Pacific, respectively. The annual incidence of hepatocellular carcinoma (HCC) among patients with alcohol-associated cirrhosis ranged from 0.9% to 5.6%. Alcohol was associated with approximately one-fifth of global HCC-related deaths in 2019. Between 2012 and 2017, the global estimated ASDR for alcohol-associated cirrhosis declined, but the ASDR for alcohol-associated liver cancer increased. Measures are required to curb heavy alcohol consumption to reduce the burden of alcohol-associated cirrhosis and HCC. Degree of alcohol intake, sex, older age, obesity, type 2 diabetes mellitus, gut microbial dysbiosis and genetic variants are key factors in the development of alcohol-associated cirrhosis and HCC. In this Review, we discuss the global epidemiology, projections and risk factors for alcohol-associated cirrhosis and HCC.
Global alcohol consumption has increased in the past two decades and is projected to increase further. In this Review, Loomba and colleagues discuss the global epidemiology of alcohol-associated cirrhosis and hepatocellular carcinoma, including risk factors, trends and projections.
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; Mathurin, Philippe 2 ; Cortez-Pinto, Helena 3 ; Loomba, Rohit 4
1 University of California at San Diego, NAFLD Research Center, Division of Gastroenterology, San Diego, USA (GRID:grid.266100.3) (ISNI:0000 0001 2107 4242); National University of Singapore, Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore (GRID:grid.4280.e) (ISNI:0000 0001 2180 6431); National University Health System, Division of Gastroenterology and Hepatology, Department of Medicine, Singapore, Singapore (GRID:grid.410759.e) (ISNI:0000 0004 0451 6143)
2 Service des Maladies de l’appareil digestif, Hôpital Huriez, Lille, France (GRID:grid.413875.c) (ISNI:0000 0004 0639 4004); Unité INSERM 995, Faculté de médecine, Lille, France (GRID:grid.503422.2) (ISNI:0000 0001 2242 6780)
3 Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Departamento de Gastrenterologia, Centro Hospitalar Lisboa Norte, Lisboa, Portugal (GRID:grid.418341.b) (ISNI:0000 0004 0474 1607)
4 University of California at San Diego, NAFLD Research Center, Division of Gastroenterology, San Diego, USA (GRID:grid.266100.3) (ISNI:0000 0001 2107 4242); University of California at San Diego, Division of Epidemiology, Department of Family Medicine and Public Health, San Diego, USA (GRID:grid.266100.3) (ISNI:0000 0001 2107 4242)