Age, period and cohort trends in hospital admissions for alcohol-related liver disease in Australia, 1993–2020

Abstract

Introduction

This study examines trends in admissions for alcohol-related liver disease (ALD) for Australian men and women between 1993 and 2020 and disaggregates these trends into age, period and cohort components.

Method

Retrospective age-period-cohort analysis of hospital admissions with a primary diagnosis of ALD. Setting: Australia. Cases: 133,705 hospital admissions – 97,755 men (73%); 35,950 women (27%). Measurements: Hospital admissions for ALD were grouped into five-year age groups (15–19, 20–24 up to 85 and over) for each financial year between 1992/93 and 2020/21.

Results

ALD admission rates were substantially higher for men than women. Rates for men increased up to 2005 and subsequently declined before an uptick in 2020. For women, rates increased steadily over the period. In age-period-cohort models, male admission rates were relatively stable over both period and cohort. For women, period effects increased steadily – compared to the period reference year of 2006, the RR for women's admission rates was 0.69 (0.65, 0.74) in 1993, increasing to 1.23 (1.18, 1.29) in 2020. Recent cohorts had significantly higher rates of hospital admission for ALD than those born earlier (e.g., women born in the 1996 cohort had an RR of 2.2 (1.8, 2.7) relative to those born in the reference year 1956).

Discussion and Conclusions

Increases in hospital admissions for ALD, especially since the COVID-19 pandemic, point to the need for effective identification and interventions for people with alcohol-use disorders at risk of chronic disease outcomes.