How Secondary Interventions Reduce the Burden of Alcohol Consumption at Risk of Cirrhosis: A Public Health Decision-Making Model

Abstract

Background

Better understanding of the kinetics of the consumption of alcohol at risk of cirrhosis (≥ 20 g/day) and the prediction of the burden of alcohol consumption are needed for public health decision-making.

Methods

Based on individual data from 45 054 individuals, collected from the French Health, Health Care and Insurance Survey between 2002 and 2014, a Markov model was developed to predict the future burden of alcohol consumption ≥ 20 g/day. This estimated the incidence of alcohol intake with an intermediate (20–50 g/day) or high (≥ 50 g/day) risk of cirrhosis. The impact of five primary or secondary interventions was evaluated between 2024 and 2030.

Results

A 1 L increase in per capita alcohol consumption was associated with a 7% increase in the risk of progression to 20–50 g/day and to ≥ 50 g/day (HR = 1.07, 95% CI 1.06–1.07). Female gender was associated with a lower risk (HR = 0.47, 95% CI 0.43–0.51) and age < 45 years with a higher risk (HR = 4.15, 95% CI 2.60–6.63) of consuming ≥ 50 g/day. In 2023, 2.5 million French individuals aged 15–74 years old drank ≥ 20 g/day (5.5%), and 435 000 of these drank ≥ 50 g/day. Based on the status quo (SQ), this prevalence would be 5.1% in 2030, and would not be influenced by primary prevention, but would be reduced by secondary interventions (from −2.0% to −13.7% compared to the SQ depending on the rate of implementation).

Conclusions

Primary interventions are important to reduce the overall impact of alcohol on health. The strategy of targeting individuals who already drink ≥ 20 g/day of alcohol is more effective in reducing the short-term burden of alcohol consumption at risk of cirrhosis than primary interventions. Thus, primary and secondary interventions need to be implemented jointly.