The contribution of alcohol-use disorder to decompensated cirrhosis among people with hepatitis C: an international comparison study

Maryam Alavi, Naveed Z. Janjua, Mei Chong, Jason Grebely, Esther J. Aspinall, Hamish Innes, Heather M. Valerio, Behzad Hajarizadeh, Peter C. Hayes, Mel Krajden, Janaki Amin, Matthew G. Law, Jacob George, David J. Goldberg, Sharon J. Hutchinson, Gregory J. Dore

Research output: Contribution to journalArticlepeer-review

112 Downloads (Pure)


Background and aims: The advent of direct-acting antivirals (DAAs) has led to ambitious targets for hepatitis C virus (HCV) elimination. However, in the context of alcohol use disorder the ability of DAAs to achieve these targets may be compromised. The aim of this study was to evaluate the contribution of alcohol use disorder to HCV-related decompensated cirrhosis in three settings.
Methods: HCV notifications from British Columbia (BC), Canada, New South Wales (NSW), Australia, and Scotland (1995-2011/2012/2013, respectively) were linked to hospital admissions (2001-2012/2013/2014, respectively). Alcohol-use disorder was defined by non-liver-related hospitalisation due to alcohol use. Age-standardised decompensated cirrhosis incidence rates were plotted, associated factors were assessed using Cox regression, and alcohol-use disorder-associated population attributable fractions (PAFs) were computed. Results: Among 58,487, 84,529, and 31,924 people with HCV in BC, NSW, and Scotland, 2,689 (4.6%), 3,169 (3.7%), and 1,375 (4.3%) had a decompensated cirrhosis diagnosis, and 28%, 32%, and 50% of those with decompensated cirrhosis had alcohol-use disorder, respectively. Age-standardised decompensated cirrhosis incidence rates were considerably higher among people with alcohol-use disorder in NSW and Scotland. Decompensated cirrhosis was independently associated with alcohol-use disorder in BC, aHR 1.92, 95% CI 1.76, 2.10; NSW, aHR 3.68, 95% CI 3.38, 4.00, and; Scotland, aHR 3.88, 95% CI 3.42, 4.40. The PAFs of decompensated cirrhosis-related to alcohol-use disorder were 13%, 25%, and 40% in BC, NSW, and Scotland, respectively.
Conclusions: Alcohol-use disorder was a major contributor to HCV liver disease burden in all settings, more distinctly in Scotland. The extent to which alcohol use would compromise the individual and population level benefits of direct-acting antiviral therapy (DAA) needs to be closely monitored. Countries, where appropriate, must develop strategies combining DAA treatment uptake promotion and alcohol-use disorder management, if World Health Organization 2030 HCV mortality reduction targets are to be achieved.
Original languageEnglish
Pages (from-to)393-401
Number of pages9
JournalJournal of Hepatology
Issue number3
Early online date26 Oct 2017
Publication statusPublished - 1 Mar 2018


  • alcohol
  • cirrhosis
  • hepatitis C
  • virology
  • HCV
  • liver disease
  • alcohol use disorder
  • population-based
  • data linkage


Dive into the research topics of 'The contribution of alcohol-use disorder to decompensated cirrhosis among people with hepatitis C: an international comparison study'. Together they form a unique fingerprint.

Cite this