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USA: The devastating impact of alcohol abuse

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Deaths from cirrhosis of the liver and liver cancer are on the rise

In the USA, there is a great deal of concern regarding the increase of suicides and deaths related to the use of drugs. However, there’s another crisis that’s just as worrying, suggests Ed Cara on Gizmodo.com: the rising death toll of alcohol-related diseases, such as cirrhosis and liver cancer. A study published on July 18 by the British Medical Journal (BMJ) warns about this phenomenon.

The study, performed by researchers at the University of Michigan, examined data from death certificates gathered by the Centers for Disease Control and Prevention (CDC). The results show that from 1999 to 2016, nearly half a million Americans — 460,760, to be precise—died from cirrhosis, and an additional 136,442 died from hepatocellular carcinoma, which is the most common form of liver cancer—which is almost always a consequence of cirrhosis.

A rise in deaths

What particularly struck the team of researchers was the fact that, from 1999 to 2016, there was a 65% jump in deaths from cirrhosis. While in 1999 there were 20,661 deaths from cirrhosis, in 2016 the number had risen to 34,174. During the same period of time, the study found, deaths from liver cancer doubled, from 5,112 in 1999 to 11,073 in 2016.

A second aspect that invites reflection is the fact that “the rise was even starker when compared to other causes of deaths,” writes Ed Cara. “The cancer death rate in general had actually dropped over the same time period, as did deaths from cardiovascular disease, infections, and respiratory disease,” Cara reports.

Both of these liver diseases affect men more than women. In the case of cirrhosis, the ratio between men and women affected was 2:1, while for liver cancer it was as much as 4:1.

The authors only found a drop in the cirrhosis-related death rate in one state—Maryland—whereas significant increases were found in the South and West, especially Kentucky, New Mexico, Arkansas, Indiana, and Alabama.

In the case of liver cancer, the most notable increases in the annual death rate were found in Arizona and Kansas. No state was found to have a decrease in the mortality rate from liver cancer.

Categories

Various subgroups considered in the research directed by Elliot B. Tapper showed “statistically significant declines in cirrhosis-related mortality” in the period from 1999 to 2008, but this encouraging progress was reversed starting in 2009 in practically every demographic subgroup, a tendency that lasted at least until 2016.

The study predicts that deaths in the USA due to cirrhosis will triple by 2030; from 2009 to 2016, the most dramatic average annual increase of death from cirrhosis took place in the 25-34 age range: 10.5%, which can be attributed entirely to the consumption, or rather abuse, of alcohol, the study emphasizes.

In this same age range, cirrhosis had an especially large impact on two demographic subgroups: White Americans and Native Americans. These two groups showed the fastest increase. The study points out that “by 2016, cirrhosis accounted for 6.3% (up from 4.3% in 2009) and 7.0% (up from 5.8% in 2009) of deaths for Native Americans aged 25-34 and 35 or more, respectively.”

Causes and collateral damage

As for the causes of this upward trend, which began between 2008 and 2009, the study’s main author, Tapper, considers that there may be a link to the Great Recession, the global economic crisis that exploded in 2007 after the real estate bubble burst in the USA.

“If this trend starts in 2008, it’s pretty easy to associate that with the most traumatic national event to happen in recent time. And there is data that links new poverty or unemployment to increased alcohol-related misuse in young men,” said Tapper, quoted by Gizmodo.com.

As the study’s lead author observes, “the rise in alcohol-related cirrhosis is likely obscuring genuine breakthroughs in preventing other causes of liver disease, such as hepatitis C.” Thanks to a new class of drugs, “we cured more cases of hepatitis C in 2015 than we had in all prior years combined, and we’re making huge strides,” Tapper explains, “but we don’t see any improvements in the mortality.”

Alcohol and pancreatitis

In some countries including Great Britain, binge drinking—consuming great quantities of alcohol in a short period of time, often with the express purpose of getting drunk—is widespread. An article published last May 30 by The Guardian brings this to light. The phenomenon is so common that the head of England’s National Health Services (NHS), Simon Stephens, says that the organization’s initials are starting to stand for the “National Hangover Service”.

The article reminds readers that alcohol can cause not only cirrhosis and liver cancer, but also pancreatitis—inflammation of the pancreas. Chronic pancreatitis is particularly devastating, as it is practically a “terminal prognosis”: one in five people with this disease die within five years of diagnosis.

It’s an incurable disease which is also very painful and accompanied by very burdensome symptoms. “You can get pancreatitis after a single binge,” says Dr. Sarah Jarvis, of the campaign group Drinkaware. The organization’s website also emphasizes the connection between alcohol and the incidence of breast cancer, in men as well as women.

In 2016 in England, 7,327 deaths directly related to alcohol consumption or abuse were recorded. It’s a significant increase as compared to 2001, when the number was 5,701.

Who drinks most in Europe?

According to a study carried out by researchers at the Norwegian University of Science and Technology (NTNU) based on inverviews with 40,000 European citizens in 20 countries (plus Israel), the Irish, English, and Portuguese are the greatest consumers of alcohol in Europe. The study also reveals that men drink approximately twice as much as women on average, and that women from central-eastern Europe are the people who tend to drink the least.

In Northern Europe, the Danish are those who drink the most. “Overall alcohol consumption is highest in the upper social strata, but binge drinking is most common in the lower social strata,” said Professor Terje A. Eikemo, of the NTNU, in a press release.

When it comes to binge drinking, the Portuguese take first place, followed by the English. Nearly one in five Portuguese engages in binge drinking (17.5%), compared to close to one British citizen in nine (11.2%). Considering only women who binge drink, the Portuguese are in the lead here as well (5.2%), followed by the Dutch (5.1%) and the English (4%, or one in 25).

The situation in Italy seems less grave; according to data from the National Institute of Statistics (Istat) for the year 2016, “among adolescents, the consumption of alcohol, both daily (very moderate) and occasional, drops noticeably (from 29% to 20.4%), albeit with some variation up and down in recent years.”

At the same time, binge drinking does exist in Italy as well. The phenomenon occurs particularly among “people over 65 years of age (36.2% of men and 8.3% of women), young people aged 18-24 (22.8% and 12.2%), and adolescents aged 11-17 (22.9% and 17.9%)”, according to Istat.

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