Canadian Institute for Substance Use Research, Victoria, Canada.
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA.
Drug Alcohol Rev. 2022 Jul;41(5):1245-1253. doi: 10.1111/dar.13470. Epub 2022 Apr 1.
Alcohol is a leading contributor to liver disease, however, estimating the proportion of liver disease deaths attributable to alcohol use can be methodologically challenging.
We compared three approaches for estimating alcohol-attributable liver disease deaths (AALDD), using the USA as an example. One involved summing deaths from alcoholic liver disease and a proportion from unspecified cirrhosis (direct method); two used population attributable fraction (PAF) methodology, including one that adjusted for per capita alcohol sales. For PAFs, the 2011-2015 Behavioral Risk Factor Surveillance System and per capita sales from the Alcohol Epidemiologic Data System were used to derive alcohol consumption prevalence estimates at various levels (excessive alcohol use was defined by medium and high consumption levels). Prevalence estimates were used with relative risks from two meta-analyses, and PAFs were applied to the 2011-2015 average annual number of deaths from alcoholic cirrhosis and unspecified cirrhosis (using National Vital Statistics System data) to estimate AALDD.
The number of AALDD was higher using the direct method (28 345 annually) than the PAF methods, but similar when alcohol prevalence was adjusted using per capita sales and all alcohol consumption levels were considered (e.g. 25 145 AALDD). Using the PAF method, disaggregating non-drinkers into lifetime abstainers and former drinkers to incorporate relative risks for former drinkers yielded higher AALDD estimates (e.g. 27 686) than methods with all non-drinkers combined.
Using PAF methods that adjust for per capita sales and model risks for former drinkers yield more complete and possibly more valid AALDD estimates.
酒精是导致肝病的主要原因之一，然而，估计与饮酒相关的肝病死亡比例在方法学上具有挑战性。
我们以美国为例，比较了三种估计酒精性肝病死亡归因（AALDD）的方法。一种方法是将酒精性肝病死亡和一部分未指明的肝硬化死亡相加（直接法）；两种方法使用人群归因分数（PAF）方法，包括一种调整人均酒精销售的方法。对于 PAF，使用 2011-2015 年行为风险因素监测系统和酒精流行病学数据系统的人均销售额来推导不同水平的酒精消费流行率估计值（过量饮酒定义为中高消费水平）。使用两项荟萃分析的相对风险来估计流行率，将 PAF 应用于 2011-2015 年每年死于酒精性肝硬化和未指明肝硬化的平均人数（使用国家生命统计系统数据），以估计 AALDD。
直接法（每年 28345 人）估计的 AALDD 数量高于 PAF 方法，但当使用人均销售额调整酒精流行率并考虑所有酒精消费水平时，结果相似（例如，每年 25145 人归因于酒精性肝病死亡）。使用 PAF 方法，将非饮酒者细分为终身戒酒者和曾经饮酒者，以纳入曾经饮酒者的相对风险，得出的 AALDD 估计值高于将所有非饮酒者合并的方法（例如，每年 27686 人归因于酒精性肝病死亡）。
使用调整人均销售额和模型风险的 PAF 方法可以得出更完整和可能更有效的 AALDD 估计值。
