John Ulrich, Hanke Monika
Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.
BMC Res Notes. 2015 Dec 26;8:822. doi: 10.1186/s13104-015-1808-2.
The relationship between alcohol consumption and liver cirrhosis mortality has been revealed by data from several different countries. However, the impact of tobacco smoking on liver cirrhosis has not been considered. The aim of this study was to estimate trends in liver cirrhosis mortality and alcohol and tobacco consumption from 1952 to 2013 as well as more recent trends in substance use disorder treatments and hospital treatments of liver diseases in Germany.
Data from the National Statistics Office were used. Liver cirrhosis was diagnosed according to the International Classification of Diseases (ICD-6 to ICD-10). Alcohol beverages and tobacco products were estimated according to tax or governmental data. Substance use disorder treatment and hospital treatment data were used. Trends were calculated using Joinpoint regression analyses.
Liver cirrhosis mortality among men increased annually by 8.4% from 1952 to 1960 and increased annually by 2.8% from 1961 to 1976. From 1976 to 1982, liver cirrhosis mortality decreased annually by 4.8%, from 1982 to 2013 liver cirrhosis mortality decreased annually by 1.2%. Among females, liver cirrhosis mortality increased annually by 8.9% from 1952 to 1959 and by 4.3% from 1959 to 1968, but then decreased 1.0% annually from 1968 to 1995. After 1995, liver cirrhosis mortality decreased 1.9% annually through 2013. These reductions in liver cirrhosis mortality were accompanied by decreases in alcohol consumption beginning in 1976. These findings were also accompanied by decreases in the consumption of cigarette equivalents since 1971. Meanwhile, the number of substance use disorder treatments and hospital treatments of liver diseases increased.
The decrease in liver cirrhosis mortality may have been caused by a decrease in alcohol drinking and tobacco smoking. Smoking may have exerted indirect effects via alcohol consumption as well as direct effects. These trends existed despite largely missing preventive efforts to reduce alcohol consumption and tobacco smoking. Increases in educational attainment in the general population may have contributed to the reductions in alcohol and tobacco consumption. Convincing evidence that the increased provision of substance use disorder treatment significantly contributed to the decrease of liver cirrhosis was not found.
来自几个不同国家的数据揭示了饮酒与肝硬化死亡率之间的关系。然而，吸烟对肝硬化的影响尚未得到考虑。本研究的目的是估计1952年至2013年期间肝硬化死亡率以及酒精和烟草消费的趋势，以及德国近期物质使用障碍治疗和肝病住院治疗的趋势。
使用了国家统计局的数据。根据国际疾病分类（ICD - 6至ICD - 10）诊断肝硬化。根据税收或政府数据估算酒精饮料和烟草产品。使用了物质使用障碍治疗和住院治疗数据。使用Joinpoint回归分析计算趋势。
1952年至1960年，男性肝硬化死亡率每年增加8.4%，1961年至1976年每年增加2.8%。1976年至1982年，肝硬化死亡率每年下降4.8%，1982年至2013年肝硬化死亡率每年下降1.2%。在女性中，1952年至1959年肝硬化死亡率每年增加8.9%，1959年至1968年增加4.3%，但随后在1968年至1995年每年下降1.0%。1995年后，到2013年肝硬化死亡率每年下降1.9%。肝硬化死亡率的这些下降伴随着自1976年开始的酒精消费量下降。这些发现还伴随着自1971年以来香烟等效物消费量的下降。与此同时，物质使用障碍治疗和肝病住院治疗的数量增加。
肝硬化死亡率的下降可能是由于饮酒和吸烟的减少。吸烟可能通过饮酒产生间接影响以及直接影响。尽管在很大程度上缺乏减少饮酒和吸烟的预防措施，但这些趋势依然存在。普通人群教育程度的提高可能有助于减少酒精和烟草消费。未发现有令人信服的证据表明物质使用障碍治疗的增加显著促成了肝硬化的减少。
