Risk of alcohol-related liver disease and cause-specific mortality in individuals seeking treatment for alcohol use disorder

Background & Aims: Screening for alcohol-related liver disease (ALD) is recommended in individuals with alcohol use disorder (AUD). Our aim was to compare absolute risk estimates of ALD, cancer and cardiovascular disease in individuals seeking treatment for AUD and the general population. Methods: Using nationwide healthcare registries in Denmark (2006–2022), we identified individuals in outpatient AUD treatment and matched general population comparators (1:10). Participants were followed for hospital diagnoses and cause-specific mortality. Cumulative incidence and mortality were analyzed using competing risk methods. Results: Among 47,806 individuals seeking treatment for AUD, the median age was 46 years, 71% were men, 52% drank ≥20 units of alcohol per week and 2.6% had type 2 diabetes. For individuals seeking treatment for AUD, the cumulative incidence of ALD after 10 years was 7.1% (95% CI 6.9-7.4) overall and 13% in those with type 2 diabetes, much higher than the 10-year risk of 0.6% in the 477,850 age- and sex-matched comparators. The AUD cohort had a fourfold higher 10-year all-cause mortality (17.8% vs. 4.5%), including a 10-year risk of death from ALD of 2.1% vs. 0.2%. Half of the excess deaths among individuals seeking treatment for AUD were due to alcohol-related causes or external causes. Individuals in AUD treatment were two-to threefold more likely than comparators to die from cancer or cardiovascular disease after 10 years despite a more similar disease incidence. Conclusion: This study showed the substantial burden of ALD and mortality in individuals seeking treatment for AUD. Specifically, the risk of ALD was 7% after 10 years and 13% in those with type 2 diabetes. Impact and implications: Knowledge of the absolute risk of alcohol-related liver disease (ALD) and cause-specific death among individuals in treatment for alcohol use disorder is crucial to make decisions on screening for ALD. This study highlights the need for improved care of individuals in treatment for alcohol use disorder to prevent morbidity and mortality due to ALD, other alcohol-related causes, as well as cancer and cardiovascular disease. The higher risk of ALD in those with type 2 diabetes suggests that clinicians should be specifically aware of alcohol consumption and liver disease in their patients with type 2 diabetes.