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Translational Health Economics Network (THEN), Paris, FranceInfection Antimicrobials Modeling & Evolution (IAME), UMR 1137, Institut National de la Santé et de la Recherche Médicale (INSERM) – Université Paris Diderot, Sorbonne Paris Cité, France
Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, CanadaAddiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, CanadaInstitute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, Toronto, CanadaDepartment of Psychiatry, University of Toronto, Toronto, CanadaInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
Université Paris Descartes, Sorbonne Paris Cité, Paris, FranceInstitut Pasteur, Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1223, Paris, FranceHepatology Service, Assistance Publique—Hôpitaux de Paris (AP—HP), Groupe Hospitalier Cochin Port-Royal, Paris, France
Alavi and colleagues recently found that alcohol use disorders (AUDs) were a major
contributor to decompensated cirrhosis in patients with chronic hepatitis C in Canada
(British Columbia), Australia (New South Wales), and Scotland.
However, cross-country comparisons are puzzling (Fig. 1), with population attributable fractions (PAFs) of decompensated cirrhosis associated
with AUDs ranging from 13% in Canada (British Columbia) to 72% in France. As overall
consumption of alcohol, prevalence of alcohol dependence and/or liver cirrhosis are
on the whole comparable between the four countries,
similar PAFs would be expected and differences across countries are worth further
comment.
Fig. 1Population attributable risks of decompensated cirrhosis associated with alcohol use
disorders in four countries. AUD, alcoholic use disorder; PAR, population attributable risk.
The burden of advanced liver disease has been rising in people with hepatitis C virus (HCV) infection globally.1 The prospect of increased access to direct-acting antiviral (DAA) therapies led the World Health Organization (WHO) to set ambitious targets for the elimination of HCV as a major public health threat by 2030.2 However, in settings with higher levels of alcohol use disorder, the potential for HCV treatment programmes to achieve the WHO liver mortality reduction target of 65% could be compromised, without developing concurrent strategies to reduce the consumption and impact of alcohol.
We appreciate the correspondence of Schwarzinger, Rehm, and Mallet on our study ‘‘The contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: An international study”.1 They make important points in relation to limitations of using administrative data for epidemiological research, including misclassification bias. We have discussed these limitations at length in our paper; however, we believe the generalizability of our findings (given the large sample sizes and extensive study periods) take precedence over such limitations.
