Alcohol-Attributable Fraction in Liver Disease: Does GDP Per Capita Matter?

• Main Authors: Paul T. Kröner, Pavan Kumar Mankal, Vijay Dalapathi, Kavin Shroff, Jean Abed, Donald P. Kotler
• Format: Article
• Language: English
• Published: Levy Library Press 2016-03-01
• Series: Annals of Global Health
• Subjects: alcohol-attributable fraction; per capita GDP; liver disease
• Online Access: https://annalsofglobalhealth.org/articles/1475

Background: The alcohol-attributable fraction (AAF) quantifies alcohol's disease burden. <a title="Learn more about Alcoholic Liver Disease" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/alcoholic-liver-disease">Alcoholic liver disease</a> (ALD) is influenced by <a title="Learn more about Alcohol Consumption" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/alcohol-consumption">alcohol consumption</a> per capita, duration, gender, ethnicity, and other comorbidities. In this study, we investigated the association between AAF/alcohol-related liver mortality and alcohol consumption per capita, while stratifying to per-capita gross domestic product (GDP). Methods: Data obtained from the World Health Organization and World Bank for both genders on AAF on liver disease, per-capita alcohol consumption (L/y), and per-capita GDP (USD/y) were used to conduct a <a title="Learn more about Cross Sectional Study" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/cross-sectional-study">cross-sectional study</a>. Countries were classified as “high-income” and “very low income” if their respective per-capita GDP was greater than $30,000 or less than $1,000. Differences in total alcohol consumption per capita and AAF were calculated using a 2-sample 't' test. Scatterplots were generated to supplement the Pearson correlation coefficients, and F test was conducted to assess for differences in variance of ALD between high-income and very low income countries. Findings: Twenty-six and 27 countries met the criteria for high-income and very low income countries, respectively. Alcohol consumption per capita was higher in high-income countries. AAF and alcohol consumption per capita for both genders in high-income and very low income countries had a positive correlation. The F test yielded an F value of 1.44 with 'P' = .357. No statistically significant correlation was found among alcohol types and AAF. Significantly higher mortality from ALD was found in very low income countries relative to high-income countries. Discussion: Previous studies had noted a decreased AAF in low-income countries as compared to higher-income countries. However, the non-statistically significant difference between AAF variances of low-income and high-income countries was found by this study. A possible explanation is that both high-income and low-income populations will consume sufficient amount of alcohol, irrespective of its type, enough to weigh into equivalent AAF. Conclusions: No significant difference of AAF variance was found between high-income and very low income countries relating to sex-specific alcohol consumption per capita. Alcohol consumption per capita was greater in high-income countries. Type of preferred alcohol did not correlate with AAF. ALD related mortality was less in high-income countries as a result of better developed healthcare systems. ALD remains a significant burden globally, requiring prevention from socioeconomic, medical, and political realms.