Mortality from Alcoholic Cardiomyopathy: Exploring the Gap between Estimated and Civil Registry Data

Abstract

Background: Based on civil registries, 26,000 people died from alcoholic cardiomyopathy (ACM) in 2015 globally. In the Global Burden of Disease (GBD) 2017 study, garbage coded deaths were redistributed to ACM, resulting in substantially higher ACM mortality estimates (96,669 deaths, 95% confidence interval: 82,812–97,507). We aimed to explore the gap between civil registry and GBD mortality data, accounting for alcohol exposure as a cause of ACM. Methods: ACM mortality rates were obtained from civil registries and GBD for n = 77 countries. The relationship between registered and estimated mortality rates was assessed by sex and age groups, using Pearson correlation coefficients, in addition to comparing mortality rates with population alcohol exposure—the underlying cause of ACM. Results: Among people aged 65 years or older, civil registry mortality rates of ACM decreased markedly whereas GBD mortality rates increased. The widening gap of registered and estimated mortality rates in the elderly is reflected in a decrease of correlations. The age distribution of alcohol exposure is more consistent with the distribution of civil registry rather than GBD mortality rates. Conclusions: Among older adults, GBD mortality estimates of ACM seem implausible and are inconsistent with alcohol exposure. The garbage code redistribution algorithm should include alcohol exposure for ACM and other alcohol-attributable diseases.

Past and Future Alcohol-Attributable Mortality in Europe

“…Consequently, our estimates are higher than those by Rosén and Haglund (2019) and by Trias-Llimós et al (2020)-which were only based on causes of death wholly related to alcohol [18,19]-and are lower than estimates that include all deaths from causes of death partly attributable to alcohol (e.g., external causes of death), like the estimates by Pruckner et al (2019) [17]. Secondly, we adapted the GBD alcohol-attributable mortality rates for 65+ in response to quality concerns due to the limitations of applying their estimation technique at higher ages [20,23]. Compared to the very steep increases (men) and steep declines (women) in alcohol-attributable mortality rates with age observed in the GBD data, we obtained an inverted U-shaped curve for both sexes (see Supplementary File 1-Appendix Figure A1), which is considered more realistic [20].…”

“…The GBD estimates of alcohol-attributable mortality for the highest ages (65+) are, however, considered implausible, as they are either very high or negative (e.g., [20,23]). Among the explanations for these potential inaccuracies are that the estimation technique is highly dependent on the limited information on alcohol use at these ages; age-specific relative risks (RRs) of dying are lacking at these ages; and, more generally evidence regarding the impact of alcohol on health at those ages is lacking (e.g., [20,23]).…”

The Effects of Ethanol on the Heart: Alcoholic Cardiomyopathy

“…Mortality in ACM is related to the progression of heart failure and malignant arrhythmias [58,65]. In long-term follow-up studies, a mortality rate of 10% of patients/year has been observed in the group of patients with persistent high-dose ethanol consumption [19,52].…”

Epidemiological Impact of Myocarditis

“…Thirty percent of EMBs of patients with excessive alcohol consumption showed lymphocytic infiltrates with myocyte degeneration and focal myocardial necrosis [ 119 , 120 ]. Based on data from 77 countries, alcoholic cardiomyopathy has been demonstrated in 1.54 billion adults, mainly in American and WHO European Regions [ 121 ].…”