S2930 Temporal Trends in the Incidence of Cirrhotic Alcohol-Associated Liver Disease in 3 Northern American Countries Over the Past 3 Decades

Introduction: Liver cirrhosis imposes a significant global health and socioeconomic burden due to the resultant morbidity, diminished quality of life, and mortality. Alcohol-associated liver (ALD) disease is among the leading etiologies of cirrhosis worldwide. Therefore, evaluating the temporal trends in the incidence of cirrhotic ALD is of paramount significance as it enables introduction of health policy measures. Methods: Temporal trends in the age-standardized incidence rate (ASIR) of cirrhotic ALD in the US, Canada, and Mexico for the period 1990-2019 were evaluated by retrieving relevant data from the Global Burden of Disease database. Joinpoint analysis software was utilised to calculate the Annual Percent Change (APC) and the Average Annual Percent Change (AAPC). Gender stratification was performed to evaluate for any gender differences in the incidence. Results: Over the span of 3 decades, an estimated total of 1,077,041 cirrhosis cases attributed to ALD were reported in the US, Canada, and Mexico with a man predominance of 77.6%. The majority of cases were reported in the US (55.2%), followed by Mexico (42.3%) and Canada (2.5%). Overall, a statistically significant decline was noted in the ASIR across the 3 nations with the highest decline observed in Mexico (AAPC -0.996, 95% CI -1.007 to -0.983, P < 0.001) followed by Canada (AAPC -0.535, 95% CI -0.554 to -0.516, P < 0.001). The US witnessed the lowest decline (AAPC -0.426, 95% CI -0.477 to -0.360, P < 0.001). Interestingly, gender stratification revealed variation in the trends between men and women. Men experienced a statistically significant decline in the ASIR across the 3 countries with the highest decline noted in the US (AAPC -0.613, 95% CI -0.674 to -0.550, P < 0.001) followed by Mexico (AAPC -0.601) and Canada (AAPC -0.573). In women, a statistically significant decline was also noted in Canada and Mexico, with the latter experiencing a higher decline (AAPC -2.471, 95% CI -2.522 to -2.419, P < 0.001). However, the US observed a statistically significant slight increase in the ASIR with an AAPC of 0.055 (95% CI 0.013 to 0.095, P = 0.01). Conclusion: During 1990-2019, the US, Mexico, and Canada observed a significant decline in the incidence of cirrhotic alcoholic liver disease. However, women in the US were observed to have a significant slight increase in the incidence, thus mandating prompt recognition and introduction of health policy measures to tackle the associated burden.