Prevalence of alcohol-associated liver disease: a systematic review and meta-analysis

Background: Alcohol-associated liver disease (ALD) is a common cause of morbidity and premature mortality. To date, there has been no systematic synthesis of the prevalence of ALD. This systematic review was done with the aim of reporting the prevalence of ALD across different health care settings. Methods: PubMed and EMBASE were searched for studies reporting the prevalence of ALD in populations subjected to a universal testing process. Single-proportion meta-analysis was performed to estimate the prevalence of all ALD, alcohol-associated fatty liver, and alcohol-associated cirrhosis, in unselected populations, primary care, and among patients with alcohol-use disorder (AUD). Results: Thirty-five studies were included reporting on 513,278 persons, including 5968 cases of ALD, 18,844 cases of alcohol-associated fatty liver, and 502 cases of alcohol-associated cirrhosis. In unselected populations, the prevalence of ALD was 3.5% (95% CI, 2.0%–6.0%), the prevalence in primary care was 2.6% (0.5%–11.7%), and the prevalence in groups with AUD was 51.0% (11.1%–89.3%). The prevalence of alcohol-associated cirrhosis was 0.3% (0.2%–0.4%) in general populations, 1.7% (0.3%–10.2%) in primary care, and 12.9% (4.3%–33.2%) in groups with AUD. Conclusions: Liver disease or cirrhosis due to alcohol is not common in general populations and primary care but very common among patients with coexisting AUD. Targeted interventions for liver disease such as case finding will be more effective in at-risk populations.