We read with great interest the study by Askgaard and colleagues [1]. Alcohol-related organ damage results from the complex association between the degree of consumption, socioeconomic inequalities, comorbidities, and other unknown factors, mainly affecting vulnerable populations. This problem has been described in the United Kingdom and Nordic countries but may occur at a global scale. As members of the Special Interest Group on Alcohol-Associated Liver Disease (ALD) of the Latin-American Association for the Study of the Liver (ALEH), we would like to raise several important points.
Latin-America has great ethnic heterogeneity, high alcohol consumption, and lack of public health policies related to alcohol [2,3]. In fact, there are profound socioeconomic and healthcare access inequalities, where low-income countries of the region have higher mortality from ALD, despite reporting lower alcohol consumption [4]. Furthermore, inequality in access to healthcare is one of the most critical problems in the poorest countries of Latin-America [4].
For instance, Chile is a relatively high-income country, with a significant inequality issue, and among the highest alcohol consumption in Latin-America. In a nationwide study, the proportion of Chilean current drinkers with ALD was higher among people with low-income levels, despite having a lower prevalence of alcohol consumption [5]. Therefore, these data are consistent with the presence of the ALD harm-paradox in our region [4,5]. Finally, we propose that public health policies, such in Latin-America, should be designed considering regional and cultural aspects. Such policies represent an essential tool for prevention, and timely treatment of ALD, especially in the most vulnerable populations.
Contributors
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Juan Pablo Roblero: conceptualization, writing, review, and editing.
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Luis Antonio Díaz: writing, review, and editing.
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Juan Pablo Arab: writing, review, and editing.
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Pablo Roblero: writing, review, and editing.
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Ramon Bataller: writing, review, and editing.
Financial Support
Juan Pablo Arab receive support from the Chilean government through the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT 1200227) and the Comisión Nacional de Investigación, Ciencia y Tecnología (CONICYT, AFB170005, CARE, Chile, UC).
Ramón Bataller is recipient of NIAAA U01AA021908 and U01AA020821.
Declarations of Interests
Ramon Bataller received speaking fees from Echosens. No disclosures from any other author.
References
- 1.Askgaard G, Fleming KM, Crooks C. Socioeconomic inequalities in the incidence of alcohol-related liver disease: A nationwide Danish study. The Lancet Regional Health - Europe. 2021;8 doi: 10.1016/j.lanepe.2021.100172. [DOI] [PMC free article] [PubMed] [Google Scholar]
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