Table 1.
Sources and assumptions for modelling the impact of alcohol on incidence and course of liver disease
| Mechanism | Consequence |
Exposure on (data based on [45]) | Risk relations | Further assumptions |
|---|---|---|---|---|
| All data from [46] | ||||
|
| ||||
| Heavy drinking over time on alcoholic liver cirrhosis | Alcoholic liver cirrhosisa incidence | Not applicable; alcoholic liver cirrhosis was estimated directly | Not applicable | An underestimate as it is a stigmatised disease (see text) |
| Heavy-drinking occasion on sexual transmission of HBV and HCV | Acute HBV and HCV incidence | Heavy-drinking occasions (defined as >48 g pure alcohol/day in women; >60 g/day in men; [32]) | Rehm et al., 2017 [32] | Alcohol’s impact on sexual transmission applies to all sexually transmitted diseases |
| Alcohol use is linked to decreased clearance of acute HBV and HCV leading to increased chronic HBV and HCV cases | Chronic HBV incidence; chronic HCV incidence | All populations with HBV or HCV infections -> higher average drinking level (for distribution based on mean, see [36,47]); effect on clearance only by chronic heavy drinkers [48] | Aisyah et al., 2018 [35] | Similar impact of alcohol on clearance of HBV and HCV |
| Alcohol use interaction with chronic HBV and HCV in the course of liver disease progression | Cirrhosis due to HBV; cirrhosis due to HCVa | All populations with HBV or HCV infections -> higher average drinking level (for distribution based on mean see [36,47]) | Llamosas-Falcón et al., 2020 [36] | Similar impact of alcohol on disease progression of HBV and HCV infections |
| Alcohol use interaction with obesity on liver cirrhosis | Liver cirrhosis incidencea | Chronic heavy drinkers (defined as >40 g pure alcohol/day in women; >60 g/day in men) | Patra et al., 2020 [49] | |
| Alcohol use on liver disease complications, for example liver cancer | Liver cancer incidence Liver cancer death |
Population distribution of consumption plus effect of former drinkers [50] | For drinkers: Turati et al., 2015 [51]; for former drinkers [52] | Average lag time of 10 years between exposure and outcome [53] |
| Continued alcohol consumption on chronic liver disease death (excluding liver cancer) | Liver cirrhosis deatha (as per the broader GBD definition) | Rehm et al., 2010 [25]; for former drinkers [50] | Assumption of impact of alcohol on mortality within a year (comparative risk assessment methodology) | |
a
Liver cirrhosis is defined broadly as comprising other chronic liver disease: B18-B18.9, I85-I85.9, I98.2, K70-K70.9, K71.3-K71.51, K71.7, K72.1-K74.69, K74.9, K75.8-K76.0, K76.6-K76.7, K76.9. HBV, hepatitis B virus; HCV, hepatitis C virus.