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  The International Liver Congress™
EASL - European Association for the
Study of the Liver
June 22-26 2022
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More Alcohol Public Health Policies Tied to
Fewer Alcohol, Cirrhosis, CVD Deaths, HCC

  EASL International Liver Congress 2022, London, June 22-26, 2022
Mark Mascolini
A 169-country study found that countries with a greater commitment to alcohol-related public health policies had lower mortality from cirrhosis, alcohol-associated liver disease, hepatocellular carcinoma, and cardiovascular disease [1]. The international crew of researchers who conducted this study gauged each country's commitment to alcohol-related public health measures with a newly devised tool-the preparedness index.
Alcohol use is a leading risk factor for illness, disability, and death across the world. Epidemiologists estimate that alcohol consumption accounts for 3.3 million deaths every year. To learn more about the impact of public health policies on alcohol-related mortality, the investigators conducted a worldwide ecological study involving 169 countries. They recorded public health policies on alcohol in place in 2010 from the WHO Global Information System of Alcohol and Health (GISAH). Then they figured the burden of disease due to alcohol for the years 2010 through 2019 using Global Burden of Disease databases. This work follows on earlier research that focused on Latin America [2].
To define the preparedness index, the researchers classified WHO public health policies into five domains: (1) national policies to fight harmful consequences of alcohol, (2) control over alcohol production, pricing, and taxes, (3) control over alcohol marketing and restrictions on access to alcohol, (4) policies involving drunk driving and countermeasures, and (5) monitoring and surveillance. The researchers used multiple correspondence analysis to calculate a preparedness index score for each country.
To gauge the impact of public health policies on health outcomes, the investigators used multilevel linear models with Poisson distribution. They focused on public health policies in place up to 2010 and outcomes recorded in 2010-2019. They figured outcome incidence rate ratios (IRR) adjusted for potential confounders (gross domestic product, population, and structure).
The 169 countries included 50 in Africa, 46 in Europe, 35 in the Americas, 33 in Asia, and 5 in Oceania. Median gross domestic product per capita for these countries was $6146, and median alcohol consumption per capita 6.6 liters. Median preparedness index for the 169 countries stood at 54 (interquartile range 34.9 to 76.8).
Prevalence of alcohol use disorder declined nearly significantly as the preparedness index rose (IRR 0.25, 95% confidence interval [CI] 0.06 to 1.09, P = 0.064). IRRs for alcohol use disorder were best in Africa (0.07, P = 0.075) and the Americas (0.01, P < 0.001).
A higher preparedness index had a highly significant impact on death due to cirrhosis from all causes (IRR 0.11, 95% CI 0.03 to 0.43, P = 0.001). The association between higher preparedness index and IRR for alcohol-associated liver disease mortality also reached statistical significance (IRR 0.15, 95% CI 0.03 to 0.76, P = 0.022). Again, the association between higher preparedness and lower alcohol-associated liver disease was significant in Africa (IRR 0.03, P = 0.031) and the Americas (IRR 0.01, P < 0.001), but not in Europe (IRR 1.12, P = 0.940) or Asia (IRR 10.26, P = 0.241).
The association between higher preparedness index and lower cancer mortality held true for overall cancer mortality (IRR 0.22, 95% CI 0.05 to 0.97, P = 0.046) and for hepatocellular carcinoma (IRR 0.20, 95% CI 0.04 to 1.02, nearly significant at P = 0.053). The analysis also linked higher preparedness index to lower cardiovascular mortality (IRR 0.15, 95% CI 0.04 to 0.61, P = 0.008). But higher preparedness index did not lower risk of alcoholic cardiomyopathy (IRR 0.52, 95% CI 0.08 to 3.45, P = 0.499).
The researchers concluded that their preparedness index performs well, confirming a strong association between national public health policies on alcohol and declines in alcohol-related health consequences. They found that greater preparedness had a high impact on death from cirrhosis, alcohol-related liver disease, hepatocellular carcinoma, and cardiovascular disease.
1. Díaz LA, Fuentes-López E, Idalsoaga F, et al. The number of public health policies reduces the burden and mortality of alcohol-associated liver disease worldwide: a call for action. EASL International Liver Congress 2022, London, June 22-26, 2022. Abstract OS110.
2. Díaz LA, Idalsoaga F, Fuentes-López E, et al. Impact of public health policies on alcohol-associated liver disease in Latin America: an ecological multinational study. Hepatology. 2021;:2478-2490. doi: 10.1002/hep.32016.