Reducing the Global Burden of Alcohol‐Associated Liver Disease: A Blueprint for Action

Abstract

Alcohol-associated liver disease (ALD) is a major driver of global liver related morbidity and mortality. There are 2.4 billion drinkers (950 million heavy drinkers) and the lifetime prevalence of any alcohol use disorder (AUD) is 5.1%-8.6%. In 2017, global prevalence of alcohol-associated compensated and decompensated cirrhosis was 23.6 million and 2.5 million, respectively. Combined, alcohol-associated cirrhosis and liver cancer account for 1% of all deaths worldwide with this burden expected to increase. Solutions for this growing epidemic must be multi-faceted and focused on both population and patientlevel interventions. Reductions in ALD-related morbidity and mortality require solutions that focus on early identification and intervention, reducing alcohol consumption at the population level (taxation, reduced availability and restricted promotion), and solutions tailored to local socioeconomic realities (unrecorded alcohol consumption, focused youth education). Simple screening tools and algorithms can be applied at the population level to identify alcohol misuse, diagnose ALD using non-invasive serum and imaging markers, and risk-stratify higher-risk ALD/AUD patients. Novel methods of healthcare delivery and platforms are needed (telehealth, outreach, use of non-healthcare providers, partnerships between primary and specialty care/tertiary hospitals) to proactively mitigate the global burden of ALD. An integrated approach that combines medical and AUD treatment is needed at the individual level to have the highest impact. Future needs include (1) improving quality of ALD data and standardizing care, (2) supporting innovative healthcare delivery platforms that can treat both ALD and AUD, (3) stronger and concerted advocacy by professional hepatology organizations, and (4) advancing implementation of digital interventions. (Hepatology 2021;73:2039-2050.A lcohol-associated liver disease (ALD) is a major driver of global liver-related morbidity and mortality. Around the world, in 2016, alcohol use was associated with 3 million deaths (5.3% of all deaths), surpassing hypertension and diabetes combined. (1,2) The purpose of our review is three-fold. First, we briefly review the global burden of ALD and place it in the context of relevant changes anticipated to drive future trends. Second, we discuss populationlevel screening for ALD and AUD for early recognition and management. Finally, we discuss strategies for mitigating the impact of ALD at the global level and offer focused solutions for delivering health care services at the regional and individual level. CURReNt aND FUtURe BURDeN oF alD alcohol Use and MisuseIn 2016, 2.4 billion people consumed alcohol (1.5 billion males and 0.9 billion females), and approximately 39.5% of these were heavy episodic

Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

“…Beyond awareness and education about comorbid CLD-SUD, gastroenterologists and hepatologists serving this complex population need healthcare delivery systems in place to support truly integrated care. These systems can provide early identification of comorbid CLD-SUD through screening and then extend the treatment of CLD to include comorbid SUD when present through integrated care delivery models ( 5 , 38 , 50 , 51 ).…”

Identification of a Prognostic Model Based on 2-Gene Signature and Analysis of Corresponding Tumor Microenvironment in Alcohol-Related Hepatocellular Carcinoma

“…However, there are not always satisfactory for HCC targeted therapies in partial patients due to the differences of their clinicopathological features and genes (20). For example, it is well known that alcohol consumption is a risk factor for HCC and other cancers (21)(22)(23)(24)(25), but there are still many unknown molecular mechanisms and prognostic biomarkers in alcoholrelated HCC. Therefore, prognostic biomarkers with higher prediction accuracy in predicting prognosis are urgently needed before detectable clinicopathological abnormalities in treatments of alcohol-related HCC patients.…”

Racial and Health Disparities among cirrhosis related hospitalizations in the US

“…[18] Several factors including gender, alcohol use patterns (binge use, drinking outside meals, type of alcohol, and severity of AUD), socioeconomic status, having insurance, receipt of treatment for risk factor of AUD, and specialty care for liver disease determine receipt of treatment of any liver disease including ALD. [19,20] Further, genetic polymorphisms of alcohol metabolizing enzymes may predispose an individual to AUD, and polymorphisms of PNPLA3, TMSF62, and MBOAT7 genes have been shown to predispose an individual with AUD to development of and severity of ALD. [21] Although, we were able to account for socioeconomic and insurance status, lack of availability of data on other clinical variables in the NIS database and blood samples for genetic analyses limited assessment on association of other variables with predisposition of AUD and ALD in AI/AN individuals.…”

“…Large multicenter studies are needed to examine other factors such as alcohol use patterns, receipt and type of provider care for AUD and for liver disease, genetic polymorphisms to further study mechanisms of our ndings. Further, these studies would also provide useful data to derive public health policies like prevention or treatment of AUD, early detection of silent advanced brosis, and increased access to healthcare, and reduce ALD related healthcare burden, [20] especially in AI/AN.…”