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KMID : 1143420200130493467
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Public Health Weekly Report
2020 Volume.13 No. 49 p.3467 ~ p.3483
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Prevalence and incidence of alcohol-related diseases by the level of alcohol intake
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Hwang Ye-Rin
Shin Myung-Hee
Yoo Min-Gyu
Park Sang-Ik
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Abstract
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South Korea is widely recognized as one of the world’s largest markets for alcohol. In 2015, South Korea had the highest per capita consumption of distilled spirits in the world. Despite government guidelines for moderate drinking, the health implications of high alcohol consumption are not well known among the public. Apart from the mortality rate published by the Korean Statistical Information Service (KOSIS), the prevalence and incidence of alcohol-related diseases have not been formally established. In 2018, to form part of this study, a pilot study to establish a registry for alcohol-related liver disease and diabetes was conducted and the prevalence and incidence of alcohol-related diseases were estimated. To investigate the impact of alcohol, this study estimated the risk and prognosis of alcohol-related liver diseases and diabetes based on alcohol intake levels.
This study used 2013-2017 Korea Health Insurance Review and Assessment (HIRA) data and 2002-2015 Sample Cohort data from the National Health Insurance Services (NHIS). The case definition of alcoholic liver disease was one or more claims of K70*. To estimate the alcohol intake amount among the Sample Cohort, this study extracted data from individuals who participated at least once in a national health screening. Individuals who consumed alcohol ≥2 times per week and ≥7 glasses (≥5 for women) at one time were categorized into the high intake group, those who had ≤1 per month were put into the low intake group, and the rest were put into the middle intake group. The incidence of alcohol-related diseases was estimated by the level of alcohol intake. In addition, the prognosis of chronic hepatitis and diabetes by alcohol intake was evaluated.
According to HIRA, from 2013-2017 the prevalence of alcoholic liver disease was 9/1,000 persons, and according to the Sample Cohort the prevalence was 11.76/1,000 persons in 2003 and 10.45/1,000 persons, showing no increasing trend. The incidence of alcoholic liver disease was 4.68/1,000 persons from HIRA 2013-2017, and 9.07/1,000 persons in 2003 and 4.37/1,000 persons from the Sample Cohort, showing a decreasing trend. The 10-year cumulative incidence of alcoholic liver disease was 5/100 persons in total, 3/100 persons in the low intake group, 5/100 persons in the middle intake group, and 11/100 persons in the high intake group. The incidence of chronic hepatitis and diabetes showed a U-shaped relationship with alcohol intake. The transition from chronic hepatitis to cirrhosis or liver cancer was not associated with alcohol intake. However, the development of complications among diabetics was significantly higher in the high alcohol intake group.
The prevalence and incidence of alcohol-related diseases were very low in this study. Underestimation is possible due to the ambiguous diagnostic criteria and low motivation from individuals to seek medical attention. Common chronic diseases such as chronic liver disease and diabetes could highly increase the burden by alcohol consumption. To estimate population attributable risk by alcohol, further cohort studies and patient registry studies with accurate measurements of alcohol intake are required to produce refined hazard ratios.
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KEYWORD
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Alcohol intake, Alcoholic liver disease, Chronic hepatitis, Diabetes, Incidence, Prevalence, Prognosis
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