The epidemiology and clinical characteristics of patients with newly diagnosed alcohol-related liver disease: results from population-based surveillance.
OBJECTIVE
We describe the epidemiology of outpatients newly diagnosed with chronic alcoholic liver disease and describe predictors of cirrhosis and referral for specialty care.


BACKGROUND
Alcohol is a major cause of liver disease in the United States. Most previous work has described hospitalized patients.


METHODS
Participants were identified through prospective population-based surveillance in gastroenterology practices Multnomah County, Oregon and New Haven County, Connecticut; and primary care and gastroenterology practices from Kaiser Permanente Northern California in Alameda County during 1999 to 2001. Patients were interviewed, a blood specimen obtained, and their medical record reviewed.


RESULTS
We identified 82 patients from gastroenterology practices with newly diagnosed alcoholic liver disease. Their median age was 50.0 years. 72.0% were male and 79.3% were White. The median age at initiation of alcohol use was 17.0 years. 43.9% of patients had evidence of cirrhosis at the time of diagnosis. Only 40.2% reported alcohol as the cause of their liver disease. Patients with cirrhosis were more likely to be older, have a higher median number of years of heavy alcohol consumption, and to have been hospitalized for a liver-related complication than noncirrhotic patients. An additional 83 primary care patients were more likely to be older, to be drinking alcohol at study interview, and to not have cirrhosis than patients referred for gastroenterology care.


CONCLUSIONS
Patients with alcoholic liver disease may present at a late stage and may not identify alcohol as a cause for their liver disease. Improved patient screening and education may limit morbidity and mortality.
Sofair
Andre N
AN
Yale University School of Medicine, New Haven, CT, USA. andre.sofair@yale.edu
Barry
Vaughn
V
Manos
M Michele
MM
Thomas
Ann
A
Zaman
Atif
A
Terrault
Norah A
NA
Murphy
Rosemary C
RC
Stabach
Nicole
N
Huie
Sharon
S
Van Ness
Grace
G
Bell
Beth P
BP
Bialek
Stephanie
S
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D002140:California; D002908:Chronic Disease; D003237:Connecticut; D005260:Female; D005762:Gastroenterology; D006801:Humans; D007407:Interviews as Topic; D008108:Liver Diseases, Alcoholic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D009922:Oregon; D011159:Population Surveillance / Q000379:methods; D011320:Primary Health Care