Incidence and mortality of alcoholic hepatitis in Denmark 1999–2008: A nationwide population based cohort study

doi:10.1016/j.jhep.2010.07.016

Journal of Hepatology

Volume 54, Issue 4, April 2011, Pages 760-764

https://doi.org/10.1016/j.jhep.2010.07.016 Get rights and content

Background & Aims

Alcoholic hepatitis is an acute life- and health-threatening disease that may be increasingly frequent. However, accurate and representative data on time trends in its incidence and prognosis are not available. This study aims to provide nationwide population-based estimates of alcoholic hepatitis incidence and mortality in Denmark, 1999–2008.

Methods

We identified, from the Danish National Registry of Patients, all patients with a first-time discharge diagnosis of alcoholic hepatitis from 1999 and through 2008. We also ascertained whether patients had cirrhosis. We computed the annual incidence rates as well as 28-, 84-day, 5-year, and 10-year mortality rates.

Results

We found 1951 patients with alcoholic hepatitis, 63% men. During the study decade, the annual incidence rate in the Danish population rose from 37 to 46 per 10⁶ for men and from 24 to 34 per 10⁶ for women. The steepest increase was observed among middle-aged women. The 28-day mortality rate rose from 12% to 15%, and the 84-day mortality rate rose from 14% to 24%, similarly for men and women. The increase in short-term mortality was attributable to increasing patient age and prevalence of cirrhosis. The 5-year mortality was 56% overall, 47% without cirrhosis, and 69% with cirrhosis.

Conclusions

The incidence of alcoholic hepatitis in Denmark has increased during the recent decade. The patients are older at diagnosis and more have cirrhosis, resulting in worse short-term prognosis. The long-term prognosis is grave, especially for patients with cirrhosis. The increase in incidence mirrors changes in alcohol consumption in Denmark.

Introduction

Alcoholic hepatitis is an acute health- and life threatening disease. Excessive drinking is a prerequisite and binge-drinking may confer the greatest risk [13]. Histological lesions indicative of alcoholic hepatitis are seen in 20–35% of heavy drinkers, [3], [11] some of which develop the full clinical picture: rapid-onset malaise, tender hepatomegaly, jaundice, and fever; upper gastrointestinal bleeding, ascites, and hepatic encephalopathy may also be present. The prognosis is strongly dependent on disease severity, as assessed by clinical scoring systems, e.g. Maddrey’s discriminant function [12]. The short-term prognosis reported in randomised treatment trials on severe alcoholic hepatitis is poor with one-month survival below 50% [7].

There is growing awareness that the incidence of this serious disease seems to be increasing, particularly in young people [1]. To substantiate this public health concern, analyses of time trends are needed on the incidence rate of alcoholic hepatitis within a large and well-defined population. However, no such data exist [11], [15]. Likewise, population-based studies of long-term prognosis are lacking.

We aimed to describe the incidence and short- and long-term mortality of alcoholic hepatitis in Denmark over a recent decade using data from nationwide medical databases.

Section snippets

Setting

We conducted a population-based cohort study of all patients with a hospital diagnosis of alcoholic hepatitis in the entire country of Denmark, which has a population of 5.2 million. All Danish citizens enjoy universal, tax-financed healthcare, enabling access to diagnostic and therapeutic procedures in public hospitals. No private hospital treats patients with alcoholic hepatitis.

Study population

The Danish National Registry of Patients has recorded data on all inpatients treated in Danish non-psychiatric

Descriptive data

We identified 1951 patients with alcoholic hepatitis, of whom 63% were men. The age of the patients ranged from 17 to 89 years; the median age increased during the study period from 48 to 55 years both for men and women (Table 1).

Incidence rate of alcoholic hepatitis

From 1999 and through 2008, the annual incidence rate of alcoholic hepatitis increased from 37 to 46 per 1,000,000 Danish men (by 27%), and from 24 to 34 per 1,000,000 Danish women (by 41%) (Fig. 1). The increase in incidence was seen only in the population aged 45 years

Discussion

In this nationwide study we found that from 1999 to 2009 the population incidence rate of alcoholic hepatitis increased by 27% among men and 41% among women. This increase was restricted to patients older than 45 years and it was most pronounced among women. There was also a rise in short-term mortality due to increasing patient age and growing prevalence of cirrhosis.

This is the first population based study examining the epidemiology of alcoholic hepatitis. Therefore, we are unable to directly

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

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Citation Excerpt :
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Research ArticleIncidence and mortality of alcoholic hepatitis in Denmark 1999–2008: A nationwide population based cohort study

Background & Aims

Methods

Results

Conclusions

Introduction

Section snippets

Setting

Study population

Descriptive data

Incidence rate of alcoholic hepatitis

Discussion

Conflict of interest

Gastroenterology

Clin Liver Dis

Clinical syndromes of alcoholic liver disease

Dig Dis

Age standardization of rates: a new WHO standard

The Danish National Hospital Register: a valuable source of data for modern health sciences

Dan Med Bull

Research Article
Incidence and mortality of alcoholic hepatitis in Denmark 1999–2008: A nationwide population based cohort study