Alcohol-related cirrhosis patients sicker, women disproportionately affected
Of more than 100 million privately insured people surveyed, more than one-third of cirrhosis cases can be attributed to alcohol, reveals a new study.
Among the insured group, 294,215 people had liver cirrhosis. Of this number, 105,871 or 36 percent had alcohol-related cirrhosis. These individuals (the latter group) were found to be sicker and were more frequently admitted and readmitted compared to those not related to alcohol intake. The healthcare cost difference was US$44,835 (in alcohol-related cirrhosis) compared with US$23,329 (in non-alcohol-related cirrhosis).
Dr Jessica Mellinger, a gastroenterologist and health services researcher at the University of Michigan Institute for Healthcare Policy and Innovation, said: “When I look at this data, it tells me that this is a big problem.” Furthermore, the problem may be bigger for women, who in recent years have been diagnosed with alcohol-related disorders at almost twice that of men.
In her study, Mellinger and her team looked at privately insured individuals ages 18 to 64 by accessing the Truven MarketScan Commercial Claims and Encounters database. It is the largest dataset of claims for people with private insurance obtained through their employers. They tracked participants over the course of a 7-year period and in that time, Mellinger’s team discovered that women showed a 50 percent increase in alcohol-related cirrhosis compared with men, who only showed a 30 percent increase.
Mellinger said: “Women process alcohol differently than men and they are more susceptible to damage in the liver than men. They can develop cirrhosis with less alcohol and in a shorter time frame.” The hypothesis is that women’s hormonal make-up contributes to this susceptibility. She added: “We don’t know exactly why they [women] are so much more susceptible [to alcohol damage].”
The study concluded that patients with alcohol-related cirrhosis are relatively common. The figures nearly surpass those of some common cancers. Healthcare cost for these patients is costly, sometimes as much as the cost for cancer patients. Additionally, cirrhosis has already progressed when many patients see a doctor for symptoms, preventing a chance for early diagnosis and treatment.
In response to the publication of the study, Mellinger said it is important to provide alcohol-use treatment programmes. Also, the current practice of deprioritizing alcohol-related liver disease patients from receiving a transplant has no ethical justification.
However, she did agree that they (alcohol-related cirrhosis patients) will need alcohol cessation treatment before they can be transplanted with success. "Alcohol-use treatment is effective and many patients do stop drinking, obtain transplant and do well afterward."
Getting that help to stop drinking is crucial: When patients have advanced liver disease, the only action that affects whether they live or die is if they stop drinking. "But even though the damage is still there, your liver function can improve dramatically if you stop drinking,” said Mellinger.