Influence of Comorbidities on Health-Related Quality of Life in Alcohol-Related Liver Disease: A Population-Based Survey

Karen Dombestein Elde; Peter Jepsen; Natasja Von Wowern; Matilde Winther-Jensen; Marie Holm Eliasen; Anne Illemann Christensen; Lone Galmstrup Madsen; Gro Askgaard

doi:10.1016/j.cgh.2024.09.035

Influence of Comorbidities on Health-Related Quality of Life in Alcohol-Related Liver Disease: A Population-Based Survey

Clin Gastroenterol Hepatol. 2024 Nov 7:S1542-3565(24)00987-X. doi: 10.1016/j.cgh.2024.09.035. Online ahead of print.

Authors

Karen Dombestein Elde¹, Peter Jepsen², Natasja Von Wowern³, Matilde Winther-Jensen⁴, Marie Holm Eliasen⁴, Anne Illemann Christensen⁵, Lone Galmstrup Madsen³, Gro Askgaard⁶

Affiliations

¹ Medical Department, Førde Central Hospital, Norway; Section of Gastroenterology and Hepatology, Department of Internal Medicine, Zealand University Hospital, Køge, Denmark.
² Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
³ Section of Gastroenterology and Hepatology, Department of Internal Medicine, Zealand University Hospital, Køge, Denmark.
⁴ Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
⁵ National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
⁶ Section of Gastroenterology and Hepatology, Department of Internal Medicine, Zealand University Hospital, Køge, Denmark; Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. Electronic address: gask@dadlnet.dk.

PMID: 39515548
DOI: 10.1016/j.cgh.2024.09.035

Abstract

Background and aims: Extrahepatic comorbidities are common in alcohol-related liver disease (ALD). We examined associations between burden of comorbidities, alcohol, and smoking with low health-related quality of life (HRQoL) among patients with ALD.

Methods: Patients with ALD and matched comparators were identified among respondents of the Danish National Health Survey waves in 2010-2017. Survey data included generic measures of physical and mental HRQoL (12-Item Short Form Health Survey), comorbidities, alcohol and smoking. Low HRQoL in ALD was defined as ≥1.5 SD worse than the average HRQoL in the comparators. Odds ratios (ORs) of low HRQoL were estimated with multivariable logistic regression, adjusting for potential confounders.

Results: We included 772 ALD patients, 53% of whom had cirrhosis; 37% had low physical HRQoL and 22% had low mental HRQoL. Disc herniation (found in 21%), osteoarthritis (36%), chronic obstructive pulmonary disease (11%), cancer (6%), stroke (1%), and psychiatric disease (9%) were associated with low physical and/or mental HRQoL, whereas alcohol use disorder (24%), diabetes (19%), acute myocardial infarction (1%), hypertension (34%), and osteoporosis (12%) were not. For example, osteoarthritis was associated with low physical (OR, 2.17; 95% confidence interval, 1.54-3.05) and low mental (OR, 1.91; 95% confidence interval, 1.27-2.88) HRQoL. For lifestyle factors, drinking ≥20 units/week was associated with low physical and smoking ≥20 cigarettes/day with low mental HRQoL when compared with abstainers and nonsmokers, respectively.

Conclusions: Common comorbidities including chronic obstructive pulmonary disease, musculoskeletal disease, and psychiatric disease are associated with low HRQoL in ALD, independent of liver disease severity, and so are alcohol consumption and smoking. These findings highlight the importance of multidisciplinary management of patients with ALD.

Keywords: Alcohol-Related Liver Disease; Cirrhosis; Comorbidities; Health-Related Quality Of Life; Patient-Reported Outcomes.