Population drinking and liver cirrhosis mortality: is there a link in eastern Europe?

Alcohol-attributable mortality and alcohol control policy in the Baltic Countries and Poland in 2001-2020: an interrupted time-series analysis

BACKGROUND

The Baltic countries-Lithuania, Latvia and Estonia-are characterized by a high rate of fully alcohol-attributable mortality, compared with Poland. Alcohol control policy measures implemented since 2001 in the Baltic countries included a restriction on availability and an increase in excise taxation, among others. The aim of the current study was to evaluate the relationship between alcohol control policy implementation and alcohol-attributable mortality in the Baltic countries and Poland.

METHODS

Alcohol-attributable mortality data for 2001-2020 was defined by codes 100% alcohol-attributable for persons aged 15 years and older in the Baltic countries and Poland. Alcohol control policies implemented between 2001 and 2020 were identified, and their impact on alcohol-attributable mortality was evaluated using an interrupted time-series methodology by employing a generalized additive model.

RESULTS

Alcohol-attributable mortality was significantly higher in the Baltic countries, compared with Poland, for both males and females. In the final reduced model, alcohol control policy significantly reduced male alcohol-attributable mortality by 7.60% in the 12 months post-policy implementation. For females, the alcohol control policy mean-shift effect was higher, resulting in a significant reduction of alcohol-attributable mortality by 10.77% in the 12 months post-policy implementation. The interaction effects of countries and policy tested in the full model were not statistically significant, which indicated that the impact of alcohol control policy on alcohol-attributable mortality did not differ across countries for both males and females.

CONCLUSIONS

Based on the findings of the current study, alcohol control policy in the form of reduced availability and increased taxation was associated with a reduction in alcohol-attributable mortality among both males and females.

Can alcohol control policies reduce cirrhosis mortality? An interrupted time-series analysis in Lithuania

BACKGROUND AND AIMS

The relationship between alcohol consumption and cirrhosis is well established. Policies that can influence population-level use of alcohol should, in turn, impact cirrhosis. We examined the effect of population-level alcohol control policies on cirrhosis mortality rates in Lithuania - a high-income European Union country with high levels of alcohol consumption.

METHODS

Age-standardized, monthly liver mortality data (deaths per 100,000 adults, aged 15+) from Lithuania were analysed from 2001 to 2018 (n = 216 months) while controlling for economic confounders (gross domestic product and inflation). An interrupted time-series analysis was conducted to estimate the effect of three alcohol control policies implemented in 2008, 2017 and 2018 and the number of cirrhosis deaths averted.

RESULTS

There was a significant effect of the 2008 (P < .0001) and 2017 (P = .0003) alcohol control policies but a null effect of the 2018 policy (P = .40). Following the 2008 policy, the cirrhosis mortality rate dropped from 4.93 to 3.41 (95% CI: 3.02-3.80) deaths per 100,000 adults, which equated to 493 deaths averted. Further, we found that following the 2017 policy, the mortality rate dropped from 2.85 to 2.01 (95% CI: 1.50-2.52) deaths per 100,000 adults, corresponding to 245 deaths averted.

CONCLUSIONS

Our findings support the hypothesis that alcohol control policies can have a significant, immediate effect on cirrhosis mortality. These policy measures are cost-effective and aid in reducing the burden of liver disease.

Sex disparities in premature adult mortality in Estonia 1995-2016: a national register-based study

OBJECTIVES

To quantify sex disparities in cause-specific premature adult mortality in Estonia, to determine the causes of death with the largest differences, to provide insight into related behaviours and to offer some guidance to public health policy-makers based on the results of the study.

DESIGN

A national register-based study.

SETTING

Estonia.

DATA

Individual records of deaths at ages 20-69 years in 1995-2016 from the Estonian causes of death register; data on tobacco smoking and alcohol consumption in the adult population in 1996-2016 from the biennial postal survey of health behaviour.

MAIN OUTCOME MEASURES

Overall and cause-specific age-standardised mortality rates, average annual percentage changes in mortality, and cause-specific men-to-women mortality rate ratios were calculated. In addition, the age-standardised prevalence proportions of tobacco smoking and alcohol consumption and men-to-women prevalence rate ratios were determined.

RESULTS

Overall premature adult mortality decreased considerably during 1995-2016, but no reduction was observed with respect to the large relative sex disparities. In circulatory disease mortality, the disparities widened significantly over time. Extremely high mortality rate ratios were observed for cancer of the upper aerodigestive tract and for lung cancer. There was a stable, more than fivefold male excess mortality from external causes. A fourfold male disadvantage was evident for alcohol poisoning, mental disorders due to alcohol and alcohol-related degeneration of the nervous system as a group. The prevalence of tobacco smoking and harmful alcohol consumption among men exceeded that among women by factors of two and six, respectively.

CONCLUSIONS

Even though premature adult mortality has markedly decreased over time, there has been no success in diminishing the large sex differences in the mortality patterns, mostly associated with smoking and excessive alcohol consumption, both more prevalent among men. Estonia needs a comprehensive and consistent alcohol policy while maintaining and further developing antitobacco measures.

Cross-country evidence on the social determinants of the post-socialist mortality crisis in Europe: a review and performance-based hierarchy of variables

An unprecedented mortality crisis befell the former socialist countries between 1989 and 1995, representing one of the greatest demographic shocks of the period after the Second World War. While it is likely that country-level variation in the post-socialist mortality crisis in Eastern Europe can be explained by a constellation of political and socio-economic factors, no comprehensive review of the existing scholarly attempts at explaining these factors exists. We review 39 cross-national multi-variable peer reviewed studies of social determinants of mortality in post-socialist Europe in order to assess the social factors behind the post-socialist mortality crisis, determine the gaps in the existing literature and to make suggestions for future research. We propose a novel methodology to determine the relative importance of variables based on the ratio of significant to insignificant findings for each variable. The literature identifies inequality, welfare payments, religious composition, democracy, economic performance and unemployment as the leading factors that have a significant influence on mortality outcomes. Existing cross-country studies fail to establish a definitive connection between mortality and diets, drinking patterns, liberalisation, trust, health expenditure and war. We also point out that the level of analysis is not a neutral methodological choice but might influence the results themselves.

Cost of Intensive Care Treatment for Liver Disorders at Tertiary Care Level in India

BACKGROUND

Liver diseases contribute significantly to the health and economic burden globally. We undertook this study to assess the health system costs, out-of-pocket (OOP) expenditure and extent of financial risk protection associated with treatment of liver disorders in a tertiary care public sector hospital in India.

METHODOLOGY

The present study was undertaken in an intensive care unit (ICU) of a tertiary care hospital in North India. It comprised an ICU and an HDU (high dependency unit). Bottom-up micro-costing was undertaken to assess the health system costs. Data on OOP expenditure and indirect costs were collected for 150 liver disorder patients admitted to the ICU or HDU from December 2013 to October 2014. Per-patient and per-bed-day costs of treatment were estimated from both health system and patient perspectives. Financial risk protection was assessed by computing prevalence of catastrophic health expenditure as a result of OOP expenditure.

RESULTS

In 2013-2014, health system costs per patient treated in the ICU and HDU were US$2728 [Indian National Rupee (INR) 1,63,664] and US$1966 (INR 1,17,985), respectively. The mean OOP expenditures for treatment in the ICU and HDU were US$2372 (INR 1,42,297) and US$1752 (INR 1,05,093), respectively. Indirect costs of hospitalization in ICU and HDU patients were US$166 (INR 9952) and US$182 (INR 10,903), respectively.

CONCLUSION

Treatment of chronic liver disorders poses an economic challenge for both the health system and patients. There is a need to focus on prevention of liver disorders, and finding ways to treat patients without exposing their households to the catastrophic effect of OOP expenditure.

The role of birth cohorts in long-term trends in liver cirrhosis mortality across eight European countries

BACKGROUND AND AIMS

Understanding why inequalities in alcohol-related mortality trends by sex and country exist is essential for developing health policies. Birth cohort effects, indicative of differences by generation in drinking, have rarely been studied. This study estimated the relative contributions of birth cohorts to liver cirrhosis mortality trends and compared sex- and country-specific cohort patterns across eight European countries.

DESIGN

Time-series analysis of population-level mortality data.

SETTING

Austria, Finland, Hungary, Italy, the Netherlands, Poland, Spain and Sweden; 1950-2011.

PARTICIPANTS

National populations aged 15-94 years.

MEASUREMENTS

We modelled country- and sex-specific liver cirrhosis mortality (from national vital registers) adjusting for age, period and birth cohort.

FINDINGS

Birth cohorts (adjusted for age and period) made statistically significant contributions to liver cirrhosis mortality in all countries and for both sexes (P < 0.001), and more so among women (average contribution to deviance reduction of 38.8%) than among men (17.4%). The observed cohort patterns were statistically different between all but two country pairs (P < 0.001). Sex differences existed overall (P < 0.001), but not in the majority of countries (P > 0.999). Visual inspection of birth cohort patterns reveals birth cohorts at higher risk of liver cirrhosis mortality.

CONCLUSIONS

The inclusion of the birth cohort dimension improves the understanding of alcohol-attributable mortality trends in Europe. Birth cohorts at higher risk of liver cirrhosis mortality were born during 1935-49 in Sweden and Finland, around 1950 in Austria and the Netherlands and 1960 or later in Hungary, Italy, Poland and Spain.

Heavy daily alcohol intake at the population level predicts the weight of alcohol in cirrhosis burden worldwide

BACKGROUND & AIMS

Studies assessing alcohol as a population level risk factor for cirrhosis typically focus on per capita consumption. However, clinical studies indicate that daily intake is a strong predictor of alcoholic cirrhosis. We aimed to identify the determinants of alcohol's contribution to the global cirrhosis burden and to evaluate the influence of daily drinking on a population level.

METHODS

We performed a comprehensive analysis of the WHO 2014 Global Status Report on Alcohol and Health. We categorized countries by heavy or moderate drinking based on daily consumption, using U.S. Department of Agriculture definitions of heavy drinking. Additional data on cirrhosis cofactors were also obtained. Uni- and multivariate models were fitted to identify independent predictors of the alcohol-attributable fraction of cirrhosis.

RESULTS

The WHO 2014 Report found that half of cirrhosis mortality worldwide is attributable to alcohol, approximating 60% in North America and Europe. In an integrative multivariate model, the designation of countries by moderate or heavy daily drinking had the strongest influence on the weight of alcohol in the cirrhosis burden. The relative contribution from alcohol increased by 11% with a transition from the moderate to heavy classification (p<0.001). Importantly, drinking patterns such as heavy episodic drinking and the type of alcohol did not independently predict the alcohol-attributable fraction of cirrhosis.

CONCLUSIONS

Heavy daily drinking on a population level significantly influences the weight of alcohol in the cirrhosis burden. Reducing heavy drinking should be considered as an important target for public health monitoring and policies.

LAY SUMMARY

We carried out an analysis of the WHO 2014 Global Status Report on Alcohol and Health, and categorized countries by their level of drinking (heavy or moderate). We found that half of the global cirrhosis cases, and 60% in both North America and Europe are associated with alcohol intake. We concluded that on a population level heavy daily drinking significantly influences the impact of alcohol on the cirrhosis burden.

Why did life expectancy in Central and Eastern Europe suddenly improve in the 1990s? An analysis by cause of death

BACKGROUND

The upturn of life expectancy in Central and Eastern Europe in the 1990s, after a period of stagnation or even decline, is one of the main events in European population history of the late 20th century, but has not been satisfactorily explained.

DATA AND METHODS

Turning points in total and cause-specific mortality in the Czech Republic, Bulgaria, Hungary, Poland, Romania and Slovakia were determined using joinpoint regression. Changes in life expectancy in the 10 years following country-specific turning points were decomposed by age and cause of death using Arriaga's method.

RESULTS

Among men, the turning points for all-cause mortality coincided with those for ischaemic heart disease in all six countries, and sometimes also with those for liver cirrhosis, road traffic accidents and lung cancer. Among women, the pattern was more diffuse. In the 10 years since the turning point for all-cause mortality, life expectancy increased by around four years for men and three years for women in most countries. Declines in mortality from cardiovascular disease explain between a third and a half of the increase in life expectancy in all countries, but beyond this the contributing causes of death often varied considerably.

CONCLUSIONS

Although the upturn of life expectancy in Central and Eastern Europe started at different points in time, improvements in prevention and/or treatment of ischaemic heart disease appear to have played a role in all six countries. Other factors, such as changes in alcohol consumption and road traffic safety, have, however, also made important contributions in some countries.

Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis

BACKGROUND

Liver cirrhosis is a major yet largely preventable and underappreciated cause of global health loss. Variations in cirrhosis mortality at the country level reflect differences in prevalence of risk factors such as alcohol use and hepatitis B and C infection. We estimated annual age-specific mortality from liver cirrhosis in 187 countries between 1980 and 2010.

METHODS

We systematically collected vital registration and verbal autopsy data on liver cirrhosis mortality for the period 1980 to 2010. We corrected for misclassification of deaths, which included deaths attributed to improbable or nonfatal causes. We used ensemble models to estimate liver cirrhosis mortality with uncertainty by age, sex, country and year. We used out-of-sample predictive validity to select the optimal model.

RESULTS

Global liver cirrhosis deaths increased from around 676,000 (95% uncertainty interval: 452,863 to 1,004,530) in 1980 to over 1 million (1,029,042; 670,216 to 1,554,530) in 2010 (about 2% of the global total). Over the same period, the age-standardized cirrhosis mortality rate decreased by 22%. This was largely driven by decreasing cirrhosis mortality rates in China, the US and countries in Western Europe. In 2010, Egypt, followed by Moldova, had the highest age-standardized cirrhosis mortality rates, 72.7 and 71.2 deaths per 100,000, respectively, while Iceland had the lowest. In Egypt, almost one-fifth (18.1%) of all deaths in males 45- to 54-years old were due to liver cirrhosis. Liver cirrhosis mortality in Mexico is the highest in Latin America. In France and Italy, liver cirrhosis mortality fell by 50% to 60%; conversely, in the United Kingdom, mortality increased by about one-third. Mortality from liver cirrhosis was also comparatively high in Central Asia countries, particularly Mongolia, Uzbekistan and Kyrgyzstan, and in parts of sub-Saharan Africa, notably Gabon.

CONCLUSIONS

Liver cirrhosis is a significant cause of global health burden, with more than one million deaths in 2010. Our study identifies areas with high and/or rapidly increasing mortality where preventive measures to control and reduce liver cirrhosis risk factors should be urgently strengthened.

Alcohol consumption and liver disease in Australia: a time series analysis of the period 1935-2006

AIMS

The aim of the study was to examine for Australia whether the link between population alcohol consumption and liver disease mortality varies over time, using 71 years of data.

METHODS

Overall and gender-specific rates of liver disease mortality were analysed in relation to total alcohol consumption as well as for different beverage types by using autoregressive integrated moving average (ARIMA) time series methods. Separate models were developed for the entire time period and for two sub-periods (1935-1975, 1976-2006).

RESULTS

A 1-l increase in adult per capita consumption of pure alcohol led to a rise of ∼10% in overall liver disease mortality rates and a 11 and 9% increase in female and male liver disease mortality, respectively. The strength of the relationship between per capita consumption and liver disease mortality diminished over time. Spirits consumption was found to be the main driving factor in liver mortality rates between 1935 and 1975, while beer consumption was found to be the most significant predictor in liver diseases in the last three decades. In a comparative perspective, the effect of per capita alcohol consumption on liver disease in Australia is similar to the USA, Southern and Eastern Europe countries, but weaker than in Canada and western European countries.

CONCLUSION

An increase in per capita alcohol consumption in Australia is likely to lead to an increase in liver disease. Changes in the most important beverage over the study period suggest substantial shifts in drinking patterns and preferences among the heaviest Australian drinkers.

The effects of the 2006 Russian alcohol policy on alcohol-related mortality: an interrupted time series analysis

BACKGROUND

The aim of this study was to determine the impact of a set of 2006 Russian alcohol policies on alcohol-related mortality in the country.

METHODS

We used autoregressive integrated moving average interrupted time series techniques to model the impact of the policy on the number of sex-specific monthly deaths of those aged 15+ years due to alcohol poisoning, alcoholic cardiomyopathy, alcoholic liver cirrhosis, and alcohol-related mental and behavioral disorders. The time series began in January 2000 and ended in December 2010. The alcohol policy was implemented in January 2006.

RESULTS

The alcohol policy resulted in a significant gradual and sustained decline in male deaths due to alcohol poisoning (ωo = -92.631, p < 0.008, δ1 = 0.883, p < 0.001) and in significant immediate and sustained declines in male (ω0 = -63.20, p < 0.05) and female (ω0 = -64.28, p < 0.005) deaths due to alcoholic liver cirrhosis.

CONCLUSIONS

The 2006 suite of alcohol policies in Russia was responsible for an annual decline of about 6,700 male alcohol poisoning deaths and about 760 male and about 770 female alcoholic liver cirrhosis deaths. Without the alcohol policy, male alcohol poisoning deaths would have been 35% higher and male and female alcoholic liver cirrhosis deaths would have been 9 and 15% higher, respectively. We contextualize our findings in relation to declining mortality in Russia and to results from recent studies of the impact of this law on other causes of death.

The temporal relationship between per capita alcohol consumption and harm: a systematic review of time lag specifications in aggregate time series analyses

BACKGROUND

Changes in per capita alcohol consumption are temporally linked to changes in rates of alcohol-related harm. Methodological approaches for analysing this relationship have been suggested, however, the problem of time lags is not well-addressed. This study provides a review of time lag specifications, looking at (a) time to first effect on harm, (b) time to full effect and (c) the functional form of the effect accumulation from first to full effect to inform modelling of the relationship between changes in aggregate alcohol consumption and changes in rates of harm.

METHODS

Bibliographic databases were searched and citation and reference checking was used to identify studies. Included studies were time series analyses of the relationship between aggregated population alcohol consumption and rates of alcohol-related harms where time lag specifications had been derived or tested.

RESULTS

36 studies were included with liver cirrhosis, heart disease and suicide dominating the evidence base. For a large number of alcohol-related harms, no literature was identified. There was strong evidence of an immediate first effect following a change in consumption for most harms. Recommended lag specifications are proposed for a set of alcohol-attributable harms.

CONCLUSIONS

Research on time lag specifications is under-developed for most harms although we provide suggested specifications based on the findings of the review. Greater methodological attention needs to be given to the rationale for choosing or applying lag specifications and the inherent complexity of the time lag process. More consistent and transparent reporting of methodological decisions would aide progress in the field.

U.S. mortality from liver cirrhosis and alcoholic liver disease in 1999-2004: regional and state variation in relation to per capita alcohol consumption

Apparent per-capita alcohol consumption in 2001 in four U.S. regions (West, Northeast, South, and Midwest), and in 50 states was examined in relation to mortality rates (1999-2004) from liver cirrhosis and for the subcategory alcoholic liver disease. Alcohol consumption and mortality rates were highest in the west. The alcoholic liver disease mortality rate by state was strongly correlated with alcohol consumption, but several outlier or mismatch states were identified. Per-capita alcohol consumption should be useful for US public health policy, as suggested for Europe and Canada, but outlier states require further study.

Alcohol and homicide in Russia and the United States: a comparative analysis

OBJECTIVE

The object of this study was to perform a comparative analysis of the aggregate relationship between alcohol and homicide in Russia and in the United States. The comparison was based on the magnitude of the alcohol effect, the alcohol attributable fraction (AAF), and the degree to which total consumption could account for trends in homicide.

METHOD

We analyzed total and sex-specific homicide rates for the age groups 15-64 years, 15-34 years, and 35-64 years. The study period was 1959-1998 for Russia and 1950-2002 for the United States. For the United States, alcohol consumption was gauged by sales of alcohol; for Russia, estimated unrecorded consumption was included as well. The data were analyzed through autoregressive integrated moving average (ARIMA) modeling.

RESULTS

The results show that, for Russia as well as for the United States, a 1-L increase in consumption was associated with an increase in homicides of about 10%, although the absolute effect was markedly larger in Russia because of differences in homicide rates. The AAF estimates suggested that 73% and 57% of the homicides would be attributable to alcohol in Russia and in the United States, respectively. Most of the temporal variation in the Russian homicide rate could be accounted for by the trend in drinking, whereas the U.S. trend in total alcohol consumption had a more limited ability to predict the trend in homicides.

CONCLUSIONS

We conclude that the role of alcohol in homicide seems to be larger in Russia than in the United States.

Diminishing trend in alcohol poisoning mortality in Estonia: reality or coding peculiarity?

AIMS

To examine whether the changes in coding practice could reduce alcohol poisoning mortality rates in Estonia.

METHODS

Individual death records in 1983-2009 (age at death 25-64) were used to calculate the 3-year moving averages of age-standardized mortality rates. From 2000 onwards, there was a sharp increase in mortality from mental disorders due to alcohol, and at the same time a remarkable decrease in alcohol poisoning mortality. We calculated expected alcohol poisoning mortality rates for 2000-2009, assuming that mortality rate ratio of alcohol poisoning and mental disorders due to alcohol remained stable.

RESULTS

Alcohol poisoning mortality rates fluctuated considerably, being the lowest in 1988 and the highest in 1994-1995. A sharp decline started in 2000. Expected alcohol poisoning mortality rates continued their growth from 2000 onwards with a small decrease in 2006-2009. Mortality rates of mental disorders due to alcohol followed the same curve as alcohol poisoning rates up to 1999, being roughly 10 times lower than alcohol poisoning rates in both genders. From 2000 onwards, mortality from mental disorders due to alcohol increased rapidly, exceeding alcohol poisoning mortality in 2006.

CONCLUSION

This study demonstrates an obvious misclassification in coding of alcohol poisoning and mental disorders due to alcohol as underlying causes of death in the Estonian Causes of Death Registry.

Liver cirrhosis in Iceland and Sweden: incidence, aetiology and outcomes

OBJECTIVE

The objectives of this study were to investigate the incidence, aetiology and mortality of liver cirrhosis in Iceland and in Gothenburg in Sweden. Further objectives were prognosis in relation to different aetiologies and to evaluate the relationship between alcohol consumption in these countries and the incidence of alcoholic cirrhosis in recent decades. The incidence and mortality of liver cirrhosis in Iceland has been reported to be the lowest in the Western world. There are very few data on aetiology, incidence and prognosis among cirrhotics in Sweden.

MATERIAL AND METHODS

All patients diagnosed with liver cirrhosis in Gothenburg (600,000 inhabitants) and Iceland (300,000 inhabitants) during the period 1994-2003 were included.

RESULTS

A total of 918 patients in Gothenburg and 98 in Iceland were identified. The annual incidence in Gothenburg was 15.3+/-2.4/100,000 compared to 3.3+/-1.2/100,000 in Iceland (p<0.0001). In Gothenburg, 69% were male and in Iceland 52% (p<0.001). In Gothenburg, 50% of the patients had alcoholic cirrhosis compared to 29% in Iceland (p<0.0001). In Gothenburg, the patients had a higher Child-Pugh score (9.0) (SD 2.5) compared to Iceland (7.3) (SD 2.7) (p<0.0001). There was no difference in survival between patients with alcoholic liver disease and those with other aetiologies.

CONCLUSIONS

The incidence of liver cirrhosis is low in Iceland, i.e. 24% of the incidence in Gothenburg, due to the lower incidence of alcoholic and hepatitis C cirrhosis in Iceland. No increasing trends in the incidence of cirrhosis in these two countries were observed during the study period.

Alcohol mortality in Russia: a historical perspective

OBJECTIVE

To examine major changes in the supply of alcohol in Russia and its impact on health in late-tsarist and early-Soviet society.

STUDY DESIGN AND METHODS

Statistical data on acute forms of alcohol mortality were drawn from official publications and medical literature published in the period 1860-1930 that covered the 50 provinces of European Russia and some of the major cities in the Russian Empire. These data were examined for across-time changes in alcohol mortality in relation to changes in the availability of alcohol products, both in terms of increased and decreased levels of supply.

RESULTS

Rapid changes in the supply of alcoholic products in earlier periods of Russian history resulted in quick and marked changes in the levels of acute alcohol mortality. However, while restrictions on the availability of spirits have sometimes been effective in reducing alcohol mortality, there has often been a rapid recourse to alternative forms of alcohol, i.e. alcohol surrogates.

CONCLUSION

The lesson of history suggests that any attempt to deal with the problem of hazardous drinking in Russia must deal with all sources of alcohol, both legal and illegal, as individuals have demonstrated a high degree of ingenuity in identifying alternative sources of alcohol, both in the past and the present.

The influence of alcohol consumption and hepatitis B and C infections on the risk of liver cancer in Europe

BACKGROUND/AIMS

To assess the variability of liver cancer (LC) risk associated with hepatitis B (HBV) and hepatitis C (HCV) viruses and alcohol intake in 2002 throughout Europe.

METHODS

Incidence data were obtained from population-based cancer registries whereas mortality, HBV, HCV and alcohol exposures were obtained from the WHO databases. Relative risk of LC and their posterior probabilities to be >1 were obtained and plotted in maps through a Bayesian random effects model.

RESULTS

HBV prevalence >2% increased the risk of developing LC a 15% in men and 21% in women; HCV prevalence >2%, 54% in men and 33% in women and, pure alcohol intake >11l, 26% and 14%, respectively (all of them statistically significant). These risk factors played a similar role in the risk of dying from LC among men, whereas HBV and alcohol were not statistically significant among women. Significant high LC risk, after HBV/HCV and alcohol adjustment were observed for both sexes in: Hungary, Moldova, Romania, Croatia, Greece, Italy, Spain, France and Austria.

CONCLUSIONS

South-North and East-West decreasing gradients for LC risk were observed in Europe. HBV, alcohol and, mainly, HCV are independent risk factors that could explain this geographical pattern.

Alcohol and the liver

PURPOSE OF REVIEW

To update the reader with advances in epidemiology, genetics, detection, pathogenesis and therapy of alcohol-related liver disease.

RECENT FINDINGS

Ill-health due to alcohol abuse is improving in some nations but deteriorating in others. Oxidative and nitrosative stress are key to the pathogenesis of alcoholic liver disease, and there is now greater emphasis than previously on their development and role of cytochrome P450 2E1, on mitochondrial stress and disruption, (including elucidation of mitochondrial protection mechanisms) disturbance of signaling pathways and involvement of extrahepatic mediators like adiponectin. Treatment of alcoholic liver disease has stagnated, but transplantation is still favored and debated for end-stage cirrhosis.

SUMMARY

Basic and clinical research into the mechanisms of alcoholic liver disease is making headway, but has yet to produce safe and effective therapies for alcoholic hepatitis and for reversing cirrhosis.

Chronic liver disease--an increasing problem: a study of hospital admission and mortality rates in England, 1979-2005, with particular reference to alcoholic liver disease

AIMS

To determine time trends in hospital admissions for chronic liver disease in England between 1989/1990 and 2002/2003, mortality rates in England and Wales between 1979 and 2005, and the influence of alcohol-related disease on these trends.

METHODS

Hospital episode statistics for admissions in England were obtained from the Information Center for Health and Social Care and mortality data for England and Wales from the Office for National Statistics.

RESULTS

Hospital admission rates for chronic liver disease increased by 71% in males and 43% in females over the study period. This increase was largely due to alcoholic liver disease, admission rates for which more than doubled between 1989/1990 and 2002/2003. While there was a smaller rise for chronic viral hepatitis B and C, admission rates declined for hepatitis A, autoimmune hepatitis, and primary biliary cirrhosis. Mortality rates for chronic liver disease more than doubled between 1979 and 2005. Two thirds of these deaths were attributable to alcohol-related liver disease in 2005. The highest rate of alcoholic liver disease mortality was in the 45-64 age group, and the largest percentage increase between 1979 and 2005 occurred in the 25-34 age group.

CONCLUSIONS

Hospital admissions and mortality in England from chronic liver disease are increasing. The underlying reasons are complex, but alcohol-induced liver disease makes a major contribution. There are clear social and health implications if the trend continues and addressing alcohol-related liver disease should be a public health priority.

Beer consumption reduces cerebral oxidation caused by aluminum toxicity by normalizing gene expression of tumor necrotic factor alpha and several antioxidant enzymes

Aluminum (Al)-induced neurotoxicity is well known and different salts of aluminum have been reported to accelerate oxidative damage to biomolecules. The present study has examined whether silicon consumed in the form of silicic acid or beer could potentially inhibit aluminum toxicity in the brain. Male mice were administered with Al(NO(3))(3) orally at a dose of 450 mg/kg/day in drinking water for 3 month. Experimental mice were given Al(NO(3))(3) along with 50 mg/L of silicic acid or with 0.5 ml/day of beer. Al brain levels in the Al group were four times higher than those of control mice while silicic acid and beer group values were 40% lower than those of the Al group. We have observed that beer prevented accumulation of lipid damage significantly, which resulted from aluminum intake. Decline in the expression of mRNA of endogenous antioxidant enzymes associated with aluminum administration was also inhibited by beer and silicic acid. The tumor necrosis factor alpha (TNFalpha) RNA expression was normalized in silicic acid and beer groups. Very high and significant correlations were found for the different parameters tested suggesting that moderate consumption of beer, due to its silicon content, effectively protects against the neurotoxic effects of aluminum.