FIGURE 1.

State‐transition model of the natural history of ALD and drinking state. A patient is represented by the combination of one of the health states and one drinking state, shown here as rectangles and circles. Arrows between states represent annual transition probabilities, with the blue shaded states representing decompensated cirrhosis. Competing‐cause mortality, the probability of dying from other causes both related and unrelated to alcohol use, exists in every state but is not shown in our diagram for simplicity. F0, F1, and F2 represent no fibrosis (F0), mild fibrosis (F1), and moderate fibrosis (F2). F3 indicates septal fibrosis, F4 represents compensated fibrosis, and the darker blue stages represent various complications of decompensated fibrosis. The lighter shade of blue encompasses all the cirrhotic disease states. “HCC” indicates a patient has HCC, and mortality from stages F4 on contribute to the reported liver‐related mortality. The health states H1–H5 are tunnel states representing healthy liver predrinking states. These states are calibrated to reproduce the distribution of the age at first drink for the US population, as evidenced in the NESARC‐III