Global epidemiology of alcohol-associated cirrhosis and HCC: trends, projections and risk factors

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Abstract

Heavy alcohol consumption is a major cause of morbidity and mortality. Globally, alcohol per-capita consumption rose from 5.5 litres in 2005 to 6.4 litres in 2016 and is projected to increase further to 7.6 litres in 2030. In 2019, an estimated 25% of global cirrhosis deaths were associated with alcohol. The global estimated age-standardized death rate (ASDR) of alcohol-associated cirrhosis was 4.5 per 100,000 population, with the highest and lowest ASDR in Africa and the Western Pacific, respectively. The annual incidence of hepatocellular carcinoma (HCC) among patients with alcohol-associated cirrhosis ranged from 0.9% to 5.6%. Alcohol was associated with approximately one-fifth of global HCC-related deaths in 2019. Between 2012 and 2017, the global estimated ASDR for alcohol-associated cirrhosis declined, but the ASDR for alcohol-associated liver cancer increased. Measures are required to curb heavy alcohol consumption to reduce the burden of alcohol-associated cirrhosis and HCC. Degree of alcohol intake, sex, older age, obesity, type 2 diabetes mellitus, gut microbial dysbiosis and genetic variants are key factors in the development of alcohol-associated cirrhosis and HCC. In this Review, we discuss the global epidemiology, projections and risk factors for alcohol-associated cirrhosis and HCC.

Abstract

Global alcohol consumption has increased in the past two decades and is projected to increase further. In this Review, Loomba and colleagues discuss the global epidemiology of alcohol-associated cirrhosis and hepatocellular carcinoma, including risk factors, trends and projections.

Key points

Global alcohol consumption per capita rose from 5.5 litres in 2005 to 6.4 litres in 2016 and is projected to increase further to 7.6 litres in 2030.
Currently, Europe has the highest levels of alcohol consumption; however, it is projected to be surpassed by countries/regions in the Western Pacific region by 2030.
Alcohol was estimated to be associated with one-quarter of global cirrhosis deaths and one-fifth of liver cancer deaths in 2019.
Alcohol was the second-fastest-growing cause of liver-cancer deaths from 2010 to 2019.
Patients with alcohol-associated hepatocellular carcinoma (HCC) tend to present with advanced tumours, which relates at least in part to late diagnosis and limited access to HCC screening in comparison to other aetiologies of liver disease.
The risk factors for the development of cirrhosis and HCC include the amount of alcohol consumed, age, obesity, diabetes, smoking and PNPLA3 variants.

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Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Hyuna Sung, Jacques Ferlay, Rebecca Siegel … (2021)

This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

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Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Theo Vos, Stephen S Lim, Cristiana Abbafati … (2022)

Summary Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding Bill & Melinda Gates Foundation.

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Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma

Richard S Finn, Shukui Qin, Masafumi Ikeda … (2020)

The combination of atezolizumab and bevacizumab showed encouraging antitumor activity and safety in a phase 1b trial involving patients with unresectable hepatocellular carcinoma.

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Author and article information

Contributors

Rohit Loomba:

ORCID: http://orcid.org/0000-0002-4845-9991

roloomba@ucsd.edu

Journal

Journal ID (nlm-ta): Nat Rev Gastroenterol Hepatol

Journal ID (iso-abbrev): Nat Rev Gastroenterol Hepatol

Title: Nature Reviews. Gastroenterology & Hepatology

Publisher: Nature Publishing Group UK (London )

ISSN (Print): 1759-5045

ISSN (Electronic): 1759-5053

Publication date (Electronic): 18 October 2022

Pages: 1-13

Affiliations

[1 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, NAFLD Research Center, Division of Gastroenterology, , University of California at San Diego, ; San Diego, CA USA

[2 ]GRID grid.4280.e, ISNI 0000 0001 2180 6431, Department of Medicine, Yong Loo Lin School of Medicine, , National University of Singapore, ; Singapore, Singapore

[3 ]GRID grid.410759.e, ISNI 0000 0004 0451 6143, Division of Gastroenterology and Hepatology, Department of Medicine, , National University Health System, ; Singapore, Singapore

[4 ]GRID grid.413875.c, ISNI 0000 0004 0639 4004, Service des Maladies de l’appareil digestif, Hôpital Huriez, ; Lille, France

[5 ]GRID grid.503422.2, ISNI 0000 0001 2242 6780, Unité INSERM 995, Faculté de médecine, ; Lille, France

[6 ]GRID grid.418341.b, ISNI 0000 0004 0474 1607, Clínica Universitária de Gastrenterologia, Faculdade de Medicina, Departamento de Gastrenterologia, Centro Hospitalar Lisboa Norte, ; Lisboa, Portugal

[7 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, Division of Epidemiology, Department of Family Medicine and Public Health, , University of California at San Diego, ; San Diego, CA USA

Author information

Daniel Q. Huang http://orcid.org/0000-0002-5165-5061

Rohit Loomba http://orcid.org/0000-0002-4845-9991

Article

Publisher ID: 688

DOI: 10.1038/s41575-022-00688-6

PMC ID: 9579565

PubMed ID: 36258033

SO-VID: df6fc57d-257f-4ba5-82f7-d0c96fd2a915

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Global epidemiology of alcohol-associated cirrhosis and HCC: trends, projections and risk factors

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Most cited references 124

Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma

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