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Opportunities to Prevent Alcoholic Liver Cirrhosis in High-Risk Populations: A Systematic Review With Meta-Analysis. Am J Gastroenterol 2019; 114:221-232. [PMID: 30353053 DOI: 10.1038/s41395-018-0282-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alcoholic liver cirrhosis is preventable and caused by heavy drinking. Few in the general population may be at risk and interventions targeting individuals at high risk may be a more feasible opportunity for prevention than interventions targeting the whole population. METHODS We conducted a systematic review to identify opportunities to prevent alcoholic liver cirrhosis in high-risk populations. Following MOOSE guidelines, we included observational studies published between 1980 and 2017. Prospective studies of alcohol-problem cohorts were included to investigate whether alcohol-problem cohorts qualify as high-risk populations for alcoholic liver cirrhosis. Studies on the alcohol amount consumed by alcoholic liver cirrhosis patients were included to compare with the amount consumed by the general population. Moreover, studies on alcohol-related healthcare contacts prior to alcoholic liver cirrhosis diagnosis were included to identify opportunities to offer prevention interventions. Of 7198 screened references, 38 studies (N = 120,928) were included. RESULTS Alcohol-problem cohorts qualified as high-risk populations with an incidence of alcoholic liver cirrhosis ranging from 7 to 16% after 8-12 years. The alcohol amount consumed by alcoholic liver cirrhosis patients was high compared to the general population. For example, 45% (95%CI 34, 56) of alcoholic liver cirrhosis patients were drinking >110 g alcohol/day. Finally, there were opportunities to reach alcoholic liver cirrhosis patients prior to diagnosis; 40-61% of alcoholic liver cirrhosis patients had a previous alcohol-related healthcare contact. CONCLUSIONS We conclude that alcohol-problem cohorts are high-risk populations for alcoholic liver cirrhosis and there seems to be opportunities to reach later alcoholic liver cirrhosis cases with preventive interventions in healthcare settings.
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Roerecke M, Rehm J. Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis. Int J Epidemiol 2014; 43:906-19. [DOI: 10.1093/ije/dyu018] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Roerecke M, Rehm J. Alcohol use disorders and mortality: a systematic review and meta-analysis. Addiction 2013; 108:1562-78. [PMID: 23627868 DOI: 10.1111/add.12231] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/26/2013] [Accepted: 04/23/2013] [Indexed: 01/16/2023]
Abstract
AIMS To conduct a systematic review and meta-analysis on all-cause mortality in people with alcohol use disorders. METHODS Using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, studies were identified through MEDLINE, EMBASE, and Web of Science up to August, 2012. Prospective and historical cohort studies including a comparison of alcohol use disorder with a control group investigating all-cause mortality risk were included. RESULTS This meta-analysis included 81 observational studies with 221 683 observed deaths among 853 722 people with alcohol use disorder. In men, the relative risk (RR) among clinical samples was 3.38 (95% confidence interval [CI]: 2.98-3.84); in women it was 4.57 (95% CI: 3.86-5.42). Alcohol use disorders identified in general population surveys showed a twofold higher risk compared with no alcohol use disorder in men; no data were available for women. RRs were markedly higher for those ≤40 years old (ninefold in men, 13-fold in women) while still being at least twofold among those aged 60 years or older. CONCLUSIONS Mortality in people with alcohol use disorders is markedly higher than thought previously. Women have generally higher mortality risks than men. Among all people with alcohol use disorders, people in younger age groups and people in treatment show substantially higher mortality risk than others in that group.
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Affiliation(s)
- Michael Roerecke
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, Canada.
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Park S, Hong JP, Choi SH, Ahn MH. Clinical and Laboratory Predictors of All Causes Deaths and Alcohol-Attributable Deaths Among Discharged Alcohol-Dependent Patients. Alcohol Clin Exp Res 2012; 37:270-5. [DOI: 10.1111/j.1530-0277.2012.01943.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 07/05/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Subin Park
- Department of Neuropsychiatry ; Seoul National University Hospital; Seoul; South Korea
| | - Jin Pyo Hong
- Department of Psychiatry ; Asan Medical Center; Ulsan University College of Medicine; Seoul; South Korea
| | - Soon Ho Choi
- Department of Psychiatry ; Asan Medical Center; Ulsan University College of Medicine; Seoul; South Korea
| | - Myung Hee Ahn
- Department of Psychiatry ; Asan Medical Center; Ulsan University College of Medicine; Seoul; South Korea
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Park S, Kim SY, Hong JP. Cause-specific mortality of psychiatric inpatients and outpatients in a general hospital in Korea. Asia Pac J Public Health 2012; 27:164-75. [PMID: 22815305 DOI: 10.1177/1010539512452755] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study aimed to examine the cause-specific excess mortality of psychiatric patients in a general hospital in Korea. Between January 1995 and December 2006, 29 986 patients presented to the outpatient clinic of a general hospital in Seoul, Korea, or were admitted to that hospital for psychiatric disorders. Their cause-specific mortality risk was compared with that of age-matched patients from the general Korean population. The mortality risk of psychiatric patients was 1.6 times higher than that of the general population. Inpatients, younger adults, and patients with alcohol use disorders or schizophrenia had the highest standardized mortality rates (SMRs). Alcohol use disorder was associated with extremely high SMRs of more than 20 for hematological disease and digestive system disease. Effective preventive measures are required to reduce the excess mortality of psychiatric patients, particularly alcohol-dependent patients and younger patients who have been admitted for general psychiatric care.
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Affiliation(s)
- Subin Park
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Yoon Kim
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Pyo Hong
- University of Ulsan College of Medicine, Seoul, Republic of Korea
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Saieva C, Bardazzi G, Masala G, Quartini A, Ceroti M, Iozzi A, Gelain E, Querci A, Allamani A, Palli D. General and Cancer Mortality in a Large Cohort of Italian Alcoholics. Alcohol Clin Exp Res 2011; 36:342-50. [DOI: 10.1111/j.1530-0277.2011.01626.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Pompili M, Serafini G, Innamorati M, Dominici G, Ferracuti S, Kotzalidis GD, Serra G, Girardi P, Janiri L, Tatarelli R, Sher L, Lester D. Suicidal behavior and alcohol abuse. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1392-431. [PMID: 20617037 PMCID: PMC2872355 DOI: 10.3390/ijerph7041392] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/15/2010] [Accepted: 03/19/2010] [Indexed: 12/22/2022]
Abstract
Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns.
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Affiliation(s)
- Maurizio Pompili
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
- McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Author to whom correspondence should be addressed; E-Mail:
or
; Tel. +39-06 33775675; Fax +39-0633775342
| | - Gianluca Serafini
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Marco Innamorati
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Giovanni Dominici
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Stefano Ferracuti
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Giorgio D. Kotzalidis
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Giulia Serra
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Paolo Girardi
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Luigi Janiri
- Department of Psychiatry, Catholic University Medical School, Largo F. Vito 1, Rome 00168, Italy; E-Mail:
| | - Roberto Tatarelli
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Leo Sher
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; E-Mail:
| | - David Lester
- The Richard Stockton College of New Jersey, Pomona, NJ 08240-0195, USA; E-Mail:
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Noda T, Imamichi H, Tanaka H, Kawata A, Hirano K, Ando T, Yoneda H, Iwata Y, Kinoshita N. Cause-specific mortality risk among male alcoholics residing in the Osaka metropolitan area. Psychiatry Clin Neurosci 2001; 55:465-72. [PMID: 11555341 DOI: 10.1046/j.1440-1819.2001.00891.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We evaluated the mortality risk among 306 male alcoholics living in Osaka, Japan, at the time of initial diagnosis between 1972 and 1983, with regard to the cause of death, length of time from diagnosis, and participation in an alcohol abstinence self-help group. By the closing date on 1 March 1992, 110 of the 306 alcoholics had died, yielding an observed-to-expected (O/E) ratio of 4.5 [95% confidence interval (CI) = 3.7-5.4]. The alcoholics had significantly elevated mortality risks from all malignant neoplasms (O/E = 2.1, 95%CI = 1.2-3.3), esophageal cancer (O/E = 8.4, 95%CI = 1.7-24.5), diseases of the circulatory system (O/E = 4.4, 95%CI = 3.0-6.2), liver cirrhosis (O/E = 15.9, 95%CI = 10.2-23.6), diseases of the genitourinary system (O/E = 6.3, 95%CI = 1.3-18.5), and external death (O/E = 10.3, 95%CI = 6.3-15.8). The mortality risk from all causes still remained significantly high beyond the tenth year following initial diagnosis (O/E = 2.6, 95%CI = 1.0-6.2). The mortality risks from liver cirrhosis and external death (such as suicide) were highest within the first year following diagnosis, and were still high beyond the tenth year. A significantly high mortality risk from diseases of the circulatory system was observed between the first and ninth years, and the mortality risk from all malignant neoplasms was significantly elevated beyond 10 years following diagnosis. Alcoholics who did not join a self-help group soon after the initial institutional treatment had different cause-specific and time-specific mortality risks from those who did join a self-help group. These findings show the importance of long-term clinical follow-up of male alcoholics, taking into consideration the cause-specific mortality.
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Affiliation(s)
- T Noda
- Osaka Prefectural Mental Health and Welfare Center, Osaka, Japan.
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Neeleman J. A continuum of premature death. Meta-analysis of competing mortality in the psychosocially vulnerable. Int J Epidemiol 2001; 30:154-62. [PMID: 11171878 DOI: 10.1093/ije/30.1.154] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Suicide may be an extreme expression of liability to death of any type. If true, suicide risk factors should also increase other mortality, and, given exposure, excess risk should be higher for suicide than for other mortality. METHODS Of 304 publications identified in Index Medicus (1966-June 1988) by the string (suicide) and (mortality or death) and (accidental or natural), 24 reported total and cause-specific mortality associated with exposure to 16 established suicide risk factors; reference scanning yielded 122 more. These 146 publications reported on 163 cohorts (total subjects = 1179 126) mortality. Meta-analysis gave random effects standardized mortality ratios (SMR) for natural, accidental and suicidal death, stratified over the 16 risk groups. RESULTS Overall, SMR were 8.6 (95% CI : 7.1-10.4) for suicide, 3.4 (95% CI : 2.9-4.0) for accidental and 2.1 (95% CI : 1.9-2.3) for natural death. Compatible with the first hypothesis, in most groups, mortality of any type was raised. Supporting the second hypothesis, excesses increased from lowest for natural death to highest for suicide. This trend was most pronounced following deliberate self-harm, intermediate in substance abusers, and weakest, but present, in bereaved and low social class cohorts and reversed in smokers and epileptic people. CONCLUSIONS Many suicide risks apply to any type of premature death, whilst also retaining some specificity for suicide. Primary prevention, targeting such generic risk factors, will not only reduce rates of suicide but also of other types of death. Conversely, when prevention focuses on specific outcomes-such as suicide-only, other types of mortality may increase.
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Affiliation(s)
- J Neeleman
- Department of Social Psychiatry, University of Groningen, PO Box 30001, 9700 RB Groningen, Netherlands.
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Abstract
BACKGROUND We describe the increased risk of premature death from natural and from unnatural causes for the common mental disorders. METHOD With a Medline search (1966-1995) we found 152 English language reports on the mortality of mental disorder which met our inclusion criteria. From these reports, covering 27 mental disorder categories and eight treatment categories, we calculated standardised mortality ratios (SMRs) and 95% confidence intervals (CIs) for all causes of death, all natural causes and all unnatural causes; and for most, SMRs for suicide, other violent causes and specific natural causes. RESULTS Highest risks of premature death, from both natural and unnatural causes, are for substance abuse and eating disorders. Risk of death from unnatural causes is especially high for the functional disorders, particularly schizophrenia and major depression. Deaths from natural causes are markedly increased for organic mental disorders, mental retardation and epilepsy. CONCLUSION All mental disorders have an increased risk of premature death.
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Affiliation(s)
- E C Harris
- Mental Health Group, University of Southampton
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Abstract
BACKGROUND Mental disorders have a strong association with suicide. This meta-analysis, or statistical overview, of the literature gives an estimate of the suicide risk of the common mental disorders. METHOD We searched the medical literature to find reports on the mortality of mental disorders. English language reports were located on MEDLINE (1966-1993) with the search terms mental disorders', 'brain injury', 'eating disorders', 'epilepsy', 'suicide attempt', 'psychosurgery', with 'mortality' and 'follow-up studies', and from the reference lists of these reports. We abstracted 249 reports with two years or more follow-up and less than 10% loss of subjects, and compared observed numbers of suicides with those expected. A standardised mortality ratio (SMR) was calculated for each disorder. RESULTS Of 44 disorders considered, 36 have a significantly raised SMR for suicide, five have a raised SMR which fails to reach significance, one SMR is not raised and for two entries the SMR could not be calculated. CONCLUSIONS If these results can be generalised then virtually all mental disorders have an increased risk of suicide excepting mental retardation and dementia. The suicide risk is highest for functional and lowest for organic disorders with substance misuse disorders lying between. However, within these broad groupings the suicide risk varies widely.
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Affiliation(s)
- E C Harris
- University Department of Psychiatry, Southampton
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