6.14Alcohol use disorders: alcoholic liver diseases
See Background Chapter 6.14
In developed countries, alcohol is one of the 10 leading causes of disease and injury. Worldwide, in 2000, alcohol caused about 3% of all deaths (1.8 million) and about 4% of all DALYs (58.3 million).[1] Alcoholic liver disease (defined here as including alcoholic hepatitis and liver cirrhosis) is the most common cause of cirrhosis in the Western world.[2]Liver fibrosis caused by alcohol abuse and its end stage, cirrhosis, are major health care problems which are difficult to treat. These conditions would be included in the WHO Global Burden of Disease categorization as "cirrhosis of the liver".
Figure 6.14.1 shows the burden of alcoholic use disorders as a percentage of the total DALY burden (all acute and chronic conditions) across various age groups and European regions. The WHO Global Burden of Disease includes only the direct burden of the mental disorder of alcohol use, addiction and dependence in this category. In Europe, this burden peaks between the ages 15-44 at a remarkable 14%-18% of all DALYs for men of this age group, much higher than the percentage burden for men worldwide. The burden for European women in this age group is much less but is generally in the range of the global values. Across all age groups and both sexes, the EU15 countries have higher percentage disease burdens for alcoholic use disorders than the EU10 countries.
Figure 6.14.1: Alcoholic use disorders (percent of all DALYs by age group)
Source: WHO Global Burden of Disease Database
The burden of liver cirrhosis as a percentage of the total DALY burden (all acute and chronic conditions) across various age group and regions peaks between the ages 45-59 at about 4%-5% of all DALYs for men in Europe. The burden for European women in this age group is much less but is generally in the range of the global values. Over all age groups and both sexes in the age range of interest, the EU10 countries have higher liver cirrhosis disease burdens than the EU15 countries, a situation reversed from that of alcohol use disorders. The peak in distribution of liver cirrhosis is about 20 years later than that for alcohol use disorders.
There is a large gap between basic and applied research into alcoholic liver diseases.
Despite the high burden of disease and the many potential biological targets for anti-fibrotic therapies, there are very few medicines currently in clinical trials specifically directed to reverse, inhibit, or otherwise ameliorate the fibrosis and tissue destruction associated with alcoholic liver diseases.
There is little private sector funding directed to alcoholic liver diseases and public sector funding may also be insufficient, especially when compared to the enormous economic and social burdens of alcoholic liver diseases.
In principle, all alcoholic liver diseases are preventable with appropriate public health responses regarding behavioural and lifestyle change, including pharmaceutical approaches to combat alcohol addiction. However, progress in developing specific pharmaceutical interventions for alcoholic liver diseases has been hampered by poor understanding of the pathogenesis of these diseases. There is a need for better understanding of the underlying disease pathobiology and better translation between the potential targets for anti-fibrotic treatments and the medicine development process.Effective anti-fibrotic treatments are urgently needed.
[1]Rehm J, Broome R, Monteiro M, Gmel G, Graham K, Rehn N, et al. Alcohol as a risk factor for global Burden of Disease. Eur Addict Res 2003;9(4):157–164.
[2]Rehn, N, Room, R, Edwards, G. Alcohol in the European Region – consumption, harm and policies. Copenhagen: World Health Organization Regional Office for Europe; 2001.