Alcohol Consumption Analysis Among Patients with Liver Disease in China
Alcohol consumption has long been recognized as a significant contributing factor to liver damage. Despite this understanding, there has been limited research specifically examining the correlation between alcohol consumption and liver disease among patients in China. This study aims to fill this gap by determining the prevalence of alcohol consumption among patients with liver disease in China and evaluating the associated risk factors, liver diseases, and chronic medical conditions.
The study was conducted as a cross-sectional analysis involving patients with liver disease across 30 provinces, autonomous regions, and municipalities in China. Participants were asked to complete a questionnaire that included the Alcohol Use Disorders Inventory Test (AUDIT). Based on the AUDIT scores, participants were categorized into low-risk drinkers (score <8), hazardous drinkers (score 8-15), and harmful drinkers (score ≥16). The study included a total of 1489 participants, with 900 (60.44%) classified as alcohol drinkers. Among these, 8.66% were ex-drinkers, 22.10% were low-risk drinkers, 17.13% were hazardous drinkers, and 12.56% were harmful drinkers.
The analysis revealed that alcohol consumption was significantly associated with several baseline characteristics. Men under 40 years old, those with higher family annual income, individuals with a college degree or higher education, those living alone, individuals with higher body mass index (BMI), current smokers, and ex-smokers were all more likely to consume alcohol. Furthermore, among the 18.07% of participants with cirrhosis, the risk of cirrhosis increased with higher levels of alcohol consumption. Harmful drinkers also showed greater odds of hypertension and heart diseases, while both hazardous and harmful drinkers had greater odds of hyperlipidemia.
The World Health Organization (WHO) has reported that alcohol consumption contributes significantly to the global burden of disease and injury, accounting for 5.1% of the total burden. In China, alcohol consumption is a normal part of daily life, especially in rural areas, and is commonly consumed during festivals, business occasions, rituals, and special events. The Chinese Health and Nutrition Survey indicated that the alcohol consumption rate in the past year was around 34% in China. Given the high burden of hepatitis virus infections in China, which often lead to liver disease, the interaction between alcohol consumption and hepatitis B virus (HBV) or hepatitis C virus (HCV) infections is particularly concerning. Alcohol intake has been observed to independently increase the risk of cirrhosis and hepatocellular carcinoma (HCC) in patients with HBV or HCV infections.
The study also highlighted the importance of early identification of alcohol consumption behavior. In the United Kingdom, general practitioners discussed alcohol use in less than one-third of cases subsequently admitted to the hospital due to alcohol-related liver disease (ALD). This underscores the need for early identification of high-risk drinking behavior in the community or at outpatient services, where brief advice or intervention can be a cost-effective way to reduce drinking.
The study design involved a cross-sectional analysis conducted between March 1, 2018, and May 31, 2018, in 30 provinces across China. Participants were excluded if they had hepatic encephalopathy, were inebriated at the time of the interview, or had any other condition that prevented them from properly answering the questionnaire. The questionnaire included social demographic variables, lifestyle factors, liver diseases, chronic medical conditions, and alcohol consumption habits. The AUDIT score was calculated based on the participants’ responses, and additional questions were included to gather more detailed information about alcohol consumption patterns.
The results indicated that 43.56% of the alcohol-drinking population consumed alcohol monthly or less, while 54.22% had 1 or 2 drinks on a typical day. A small proportion (3.78%) of patients had a drink containing alcohol 4 or more times a week, and 10 or more drinks each time. Additionally, 41.12% of participants had 5 or more drinks on one occasion monthly. The study also found that 45.22% of participants reported being unable to stop drinking once they had started, and 41.44% failed to respond normally after drinking. Furthermore, 26.33% of participants realized they required a drink early in the morning to get going after a heavy drinking session, and 44.33% felt guilt or remorse after drinking.
The study also explored the correlation between alcohol consumption and liver diseases. It was observed that a fair number of patients were primarily infected with HBV (691/1489, 46.41%). Among the 269 (18.07%) participants with cirrhosis, the proportion was significantly high in harmful drinkers. However, no significant difference was observed in the rate of HCC between drinkers and never drinkers.
The association between alcohol consumption and chronic medical conditions was also analyzed. Harmful drinkers had greater odds of hypertension and heart diseases compared to never drinkers. Hazardous and harmful drinkers also had greater odds of hyperlipidemia. However, no significant correlation was found between diabetes mellitus or stomach illness and alcohol consumption.
The study concluded that the prevalence of alcohol consumption and alcohol dependence among patients with liver disease is high in China. Alcohol consumption is typically associated with men under 40 years old, those with higher family income, higher education levels, living alone, higher BMI, and smoking. Increased alcohol consumption not only increases the risk of cirrhosis but also enhances the risk of hypertension, heart diseases, and hyperlipidemia.
The findings of this study have important implications for public health strategies aimed at reducing alcohol consumption among patients with liver disease in China. Early identification of alcohol consumption behavior, brief interventions, and the establishment of abstinence clinics or organizations could be effective measures to mitigate the harmful effects of alcohol on liver health.
doi.org/10.1097/CM9.0000000000000043
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