Background

In 2017, the per capita alcohol consumption in Ireland equated to every Irish adult (aged 15 years and over) drinking 13.9 litres of alcohol, considerably higher than the 6.5 litres globally.1 Alcohol-related harms are associated with this level of alcohol consumption, with the period from 1995 to 2013 seeing an 82% increase in alcohol-related hospital admissions in Ireland.2,3 Alcoholic liver disease (ALD) is caused by damage to the liver from excessive drinking over a prolonged period, and treatment involves alcohol abstinence, managing complications of liver failure, and/or liver transplantation. ALD is a major cause of both liver cirrhosis and hepatocellular carcinoma (HCC), a type of primary liver cancer.

Methods

Using Hospital In-Patient Enquiry (HIPE) scheme data, a 2022 study4 examined the prevalence of ALD discharges, including HCC, from Irish hospitals during the period 2007–2016. The study examined the demographics of those discharged with a diagnosis of ALD and the ALD mortality rate as well as complications associated with ALD.

Results

According to HIPE data, during the period 2007–2016, there were 33,794 discharges with a diagnosis of ALD, increasing by 38% from 2,563 discharges in 2007 to 3,532 discharges in 2016. When examined by rates per 100,000 of the population, ALD discharges increased by 23% in the study period: from 59 per 100,000 in 2007 (based on the entire population of 4.376 million) to 73 per 100,000 in 2016 (based on the entire population of 4.76 million). Of the ALD discharges, 57% were coded as alcoholic cirrhosis of the liver, 3% as hepatorenal syndrome, 10% as acute kidney injury, and 24% as ascites. In 2016, there were 289 oesophageal variceal bleed discharges and 129 HCC discharges (a 300% increase from the 37 discharges in 2006).

The data indicated that the majority of ALD discharges during the period 2007–2016 were male (70%) and the mean age of admissions increased from 51 years in 2006 to 54 years in 2016. Patients with ALD remained in hospital for an average of 13 days; the data indicated that an average of 120 hospital beds per day were occupied due to ALD, equating to a cost of €34 million annually.

Over one-half of ALD-discharged patients were under the care of general medicine or medicinal specialities (53%), while 31% were under a gastroenterologist or hepatologist.

The overall mortality rate among those discharged with ALD was 9.8% but it varied between diagnoses. There was a 16% mortality rate for patients diagnosed with variceal bleeding; 15% for those with ascites, 42% for acute kidney injury, and 43% for hepatorenal syndrome. Overall, there was a 29% increase in hospital deaths due to ALD from 2006 (n=233) to 2016 (n=300).

Conclusion

The HIPE data analysed for this study indicated an increase in ALD discharges in Ireland during the period of investigation. Comparable data in the United Kingdom, Australia, and Brazil also reported increases in rates of ALD. The study authors acknowledged the evidence indicating that reductions in per capita alcohol consumption are associated with a reduction in alcohol-related harm3 and noted that per capita alcohol consumption in Ireland remains high.5

ALD hospitalisations highlight the considerable burden on the Irish health system and the substantial loss of life for what is a preventable condition. The authors note that the financial cost is likely to be significantly higher due to the complexity of care required for these patients and the underreporting of alcohol-attributable conditions. The authors advocate for the creation of alcohol care teams in Irish hospitals and are confident that measures commenced as part of the Public Health (Alcohol) Act 2018 will result in fewer hospital discharges due to ALD. 

1  Manthey J, Shield KD, Rylett M, Hasan OSM, Probst C and Rehm J (2019) Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. Lancet, 393(10190): 2493–2502. https://www.drugsandalcohol.ie/30508/

2  Norström T and Ramstedt M (2018) The link between per capita alcohol consumption and alcohol-related harm in Sweden, 1987–2015. J Stud Alcohol Drugs, 79(4): 578–584.

3  Long J and Mongan D (2014) Alcohol consumption in Ireland 2013: analysis of a national alcohol diary survey. Dublin: Health Research Board. https://www.drugsandalcohol.ie/22138/

4  Armstrong PR, Ring E and MacNicholas R (2022) A decade of rising alcoholic liver disease hospital admissions and deaths in Irish hospitals, 2007–2016: a retrospective cross-sectional analysis. Eur J Gastroenterol Hepatol, Early online. https://www.drugsandalcohol.ie/35445/

5  O’Dwyer C, Mongan D, Doyle A and Galvin B (2021) Alcohol consumption, alcohol-related harm and alcohol policy in Ireland. HRB Overview Series 11. Dublin: Health Research Board.
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