Global Burden of Alcohol-Associated Liver Disease, Cancer on the Rise, Study Finds

New research is shedding light on the increasing global burden of alcohol use disorder (AUD), alcohol-associated liver disease (ALD), and liver cancer attributable to alcohol, highlighting increases in prevalence, incidence, and mortality.1

Leveraging data from the Global Burden of Disease 2021, the study found a 14.66% increase in the prevalence of AUD, a 38.68% increase in the prevalence of ALD, and a 94.12% increase in the prevalence of alcohol-attributable primary liver cancer from 2000 to 2021, with significant variations observed by region, socioeconomic development level, and sex.1

According to the World Health Organization, alcohol consumption contributes to 2.6 million global deaths each year and is causally linked to more than 200 health conditions, including 30 health conditions that would not exist without alcohol use and 7 types of cancer.2,3

“While numerous studies have examined the local and regional epidemiology of ALD and AUD, there are significant gaps in understanding their global epidemiology,” Juan Pablo Arab, MD, an associate professor of medicine in the division of gastroenterology, hepatology, and nutrition at Virginia Commonwealth University School of Medicine, and colleagues wrote.1

To assess temporal trends in AUD, ALD, and alcohol-attributable primary liver cancer, investigators examined data from the Global Burden of Disease 2021 Study for incidence, prevalence, and deaths from 2000 to 2021. Estimates for AUD, ALD, and alcohol-attributable primary liver cancer were obtained from population-based cancer registries, vital registration systems, and verbal autopsy studies. Investigators noted they employed several statistical methods to enhance the consistency and reliability of the data, including misclassification correction, garbage code redistribution, and noise reduction algorithms.1

Results showed there were 111.12 million cases of AUD; 3.02 million cases of ALD; and 132,030 cases of alcohol-attributable primary liver cancer in 2021. Investigators called attention to a 14.66% increase in AUD, a 38.68% increase in ALD, and a 94.12% increase in alcohol-attributable primary liver cancer prevalence from 2000 to 2021.1

Further analysis of trends from 2000-2021 revealed an increase in the age-standardized prevalence rate (ASPR) for liver cancer from alcohol (annual percent change [APC], 0.59; 95% confidence interval [CI], 0.52 to 0.67). However, decreases were observed for ALD (APC, -0.71; 95% CI, -0.75 to -0.67) and AUD (APC, -0.90; 95% CI, -0.94 to -0.86).1

From 2019 to 2021, investigators noted AUD prevalence and incidence increased in males but decreased in females. Additionally, AUD death decreased at a higher rate in females than males. However, ALD metrics increased more in females, including prevalence (4.90% vs 3.87%), incidence (4.96% vs 3.73%), and mortality (1.07% vs 0.88%).1

The highest burden of AUD was observed in Eastern Europe, where the ASPR, age-standardized incidence rate (ASIR), and age-standardized death rate (ASDR) were 3292.73 (95% UI, 2901.33 to 3724.07); 1634.85 (95% UI, 1373.51 to 1906.75); and 10.66 (95% UI 9.82 to 11.56), respectively. When evaluated against the SDI, high SDI countries exhibited the highest burden of AUD with ASPR of 1847.63 (95% UI, 1603.23 to 2,115.44), ASIR of 915.37 (95% UI, 772.84 to 1,052.98), and ASDR of 2.58 (95% UI, 2.50 to 2.66).1

For ALD, the highest ASPR was observed in Eastern Europe (125.22; 95% UI, 102.77 to 148.78), whereas ASIR (18.56; 95% UI, 14.78 to 22.14) and ASDR (11.63; 95% UI, 9.26 to 14.28) were highest in Central Asia. Further analysis revealed high SDI countries exhibited the highest ASPR (39.37; 95% UI, 32.74 to 45.26), while low SDI countries exhibited the highest ASIR (7.79; 95% UI, 6.10 to 9.66) and ASDR (5.94; 95% UI, 4.43 to 7.78).1

The highest burden of alcohol-attributable primary liver cancer was observed in Australasia, with an ASPR, ASIR, and ASDR of 3.77 (95% UI, 3.03 to 4.61); 2.32 (95% UI, 1.87 to 2.86); and 1.92 (95% UI, 1.53 to 2.37), respectively. Of note, the ASPR increased in high (APC, 1.10; 95% CI, 1.05 to 1.16), middle (APC, 0.96; 95% CI 0.89 to 1.04); and low-middle SDI countries (APC, 0.93; 95% CI, 0.89 to 0.97).1

“Given that 49 countries exhibited an uptrend in ALD prevalence rates and 111 countries were found to have an uptrend in liver cancer prevalence rates from alcohol consumption between 2000 and 2021, it is essential to implement comprehensive strategies globally,” investigators concluded.1 “These strategies should focus on reducing alcohol intake, preventing AUD, and effectively treating its health consequences, including ALD and HCC, in all countries and territories worldwide.”

References

1. Danpanichkul P, Díaz LA, Suparan K, et al. Global Epidemiology of Alcohol-Related Liver Disease, Liver Cancer, and Alcohol Use Disorder, 2000-2021. Clin Mol Hepatol. doi:10.3350/cmh.2024.0835.
2. World Health Organization. Alcohol. Accessed January 22, 2025. https://www.who.int/health-topics/alcohol#tab=tab_1
3. World Health Organization. Alcohol use. August 21, 2024. Accessed January 22, 2025. https://www.who.int/europe/news-room/fact-sheets/item/alcohol-use