Decreasing Incidence of Alcohol-Related Liver Disease in Denmark: A 25-Year Nationwide Study

Abstract

Purpose: Alcohol consumption has decreased in Denmark in recent years. We aimed to illustrate and investigate the developments in the incidence, hospital care, and mortality of alcohol-related liver disease (ALD) in Denmark during the last 25 years. Patients and Methods: Through nationwide healthcare registries, we identified all Danish patients with incident ALD in 1994-2018. We computed standardized incidence rates by sex, age, and geography, age-specific incidence rates by birth cohort, and standardized prevalence. We enumerated inpatient admissions, days of admission, outpatient visits, and emergency room visits. Lastly, we estimated relative risks of mortality, standardized mortality rates, and the proportion of deaths caused by ALD. Results: The standardized incidence rate decreased from its peak at 357 per 1,000,000 in 2009 to 240 per 1,000,000 in 2018, and the decrease was evident for both sexes and all age groups below 70 years. The standardized prevalence was stable around 0.22% from 2011 onwards. There was an almost fivefold geographic variation in standardized incidence by municipalities, and age-specific incidence rates decreased sequentially with each 5-year birth cohort after 1960. The number of inpatient admissions, days of admission, and emergency room visits decreased during the study period, while the number of outpatient visits was stable. For patients diagnosed in 2014-2018 compared to 1994-1998, the relative risk of 1-year mortality was 0.83 (95% confidence interval: 0.78-0.87), and the standardized mortality along with the proportion of deaths caused by ALD decreased during the study period. Conclusion:The incidence of ALD decreased from 357 to 240 per 1,000,000 over the last 10 years in Denmark. During the same period, the prevalence remained stable around 0.22% and mortality decreased. Additionally, the burden of ALD on hospital care decreased significantly between 1994 and 2018. We anticipate a further decrease in the incidence of ALD in the future.

The Liverpool alcohol‐related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England

“…The majority of these studies apply standard ArLD ICD codes as the primary diagnosis to identify ArLD admissions 25,26 . However, methodology has been developed to more accurately identify alcohol‐related conditions.…”

“…A nationwide healthcare registry in Denmark found a reduction in ArLD admissions from 357 per 1,000,000 in 2009 to 240 per 1,000,000 in 2018. 18 In contrast, increases of between 33 and 38% in ArLD admissions have been documented over the decade to 2016 in Brazil, Ireland and the United States (US). 19 , 20 , 21 During the pandemic, increases in ArLD admissions have been reported in the US with a 50% increase in alcoholic hepatitis admissions reported in one city.…”

“…Furthermore, the use of the K70 ICD‐10 codes as the primary diagnosis only may miss those with alternative coding patterns. A nationwide healthcare registry in Denmark found a reduction in ArLD admissions from 357 per 1,000,000 in 2009 to 240 per 1,000,000 in 2018 18 . In contrast, increases of between 33 and 38% in ArLD admissions have been documented over the decade to 2016 in Brazil, Ireland and the United States (US) 19–21 .…”

“…24 The majority of these studies apply standard ArLD ICD codes as the primary diagnosis to identify ArLD admissions. 25,26 However, methodology has been developed to more accurately identify alcohol-related conditions. Twenty-nine alcohol-related ICD codes were agreed by expert consensus and applied to the Swedish National Patient Register to estimate incidence and prevalence of all alcohol-related disorders and diseases.…”

Brief Report: Pitfalls and Potentials in Using Methods From Action Research and Systems Thinking When Engaging and Mobilizing Participants in a Community

“…Background Rural municipalities in Denmark face several public health challenges unique to those areas and not necessarily found in more urban municipalities. More people in the outskirts of Denmark are obese and consume higher levels of alcohol compared to urban municipalities, resulting in a higher incidence of alcohol-related liver diseases-more than five times as many in some places (Kraglund et al, 2021). Thus, recruiting citizens to participate in available alcohol treatment is an crucial step in curbing alcohol-related consequences in families and the local community.…”