OBJECTIVES Alcoholic liver disease (ALD) prevalence, particularly the subset with advanced liver disease, is not well defined. Herein, we aim to provide a comprehensive assessment of ALD epidemiology across the spectrum of disease severity and across different settings using 3 unique US databases. METHODS We performed a retrospective, observational study of US adults with ALD using 2001-2016 National Health and Nutrition Examination Survey (NHANES), 2007-2014 Nationwide Inpatient Sample (NIS), and 2007-2017 United Network for Organ Sharing (UNOS) registry. ALD in the NHANES was defined using clinical laboratory data and self-reported alcohol use, among which fibrosis-4 score of >2.67 defined stage ≥3 fibrosis. Alcoholic cirrhosis (AC) in the NIS was identified using International Classification of Diseases, Ninth Revision codes. ALD in the UNOS was identified using UNOS coding. RESULTS From 2001-2002 to 2015-2016, the overall weighted ALD prevalence was stable from 8.8% to 8.1% (P = 0.102), whereas the proportion of ALD with stage ≥3 fibrosis increased from 2.2% (95% CI: 0.4-4.0) to 6.6% (95% CI: 2.0-9.9; P = 0.007) (NHANES). From 2007 to 2014, the number of hospitalizations among patients with AC per 1,000 increased by 32.8%, and the proportion of hospitalizations among the patients with AC with ≥3 cirrhosis complications increased from 11.6% in 2007 to 25.8% in 2014 (Ptrend < 0.0001) (NIS). From 2007 to 2017, the total number of adults with ALD listed for liver transplant increased by 63.4% and the proportion with concurrent hepatocellular carcinoma increased by 178% (UNOS). DISCUSSION Among these 3 US databases, consistent observations of increasing ALD severity emphasize the urgent need for greater awareness about the consequences of unhealthy alcohol use and interventions aimed specifically at addressing alcohol use disorders.

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美国酒精性肝病流行病学

目的 酒精性肝病 (ALD) 的患病率，尤其是晚期肝病亚组，尚未明确定义。在此，我们的目标是使用 3 个独特的美国数据库，对疾病严重程度范围内和不同环境中的 ALD 流行病学进行全面评估。方法 我们使用 2001-2016 年全国健康和营养检查调查 (NHANES)、2007-2014 年全国住院患者样本 (NIS) 和 2007-2017 年器官共享联合网络 (UNOS) 登记处对美国成人 ALD 进行回顾性观察性研究. NHANES 中的 ALD 是使用临床实验室数据和自我报告的酒精使用情况定义的，其中纤维化 4 评分 >2.67 定义为≥3 期纤维化。NIS 中的酒精性肝硬化 (AC) 是使用国际疾病分类第 9 版代码确定的。UNOS 中的 ALD 是使用 UNOS 编码识别的。结果 从 2001-2002 年到 2015-2016 年，总体加权 ALD 患病率稳定在 8.8% 至 8.1%（P = 0.102），而具有 3 期纤维化的 ALD 比例从 2.2%（95% CI：0.4- 4.0) 至 6.6%（95% CI：2.0-9.9；P = 0.007）（NHANES）。2007-2014年，每1000名AC患者的住院人数增加了32.8%，伴有≥3种肝硬化并发症的AC患者的住院率从2007年的11.6%上升至2014年的25.8%（Ptrend < 0.0000）。 ) (NIS)。从 2007 年到 2017 年，列入肝移植的 ALD 成人总数增加了 63.4%，并发肝细胞癌的比例增加了 178%（UNOS）。讨论 在这 3 个美国数据库中，