Burden of disease related to hepatitis C and hepatitis B in Spain: a methodological challenge of an unfolding health problem

Most previous studies of burden of disease (BoD) in the area of transmissible diseases have assessed the burden of hepatitis C and B without including the end stages of the disease and using an incident approach. We aimed to assess the disability-adjusted life years (DALYs) related to hepatitis C and B in Spain in 2006 taking into account related cirrhosis and liver cancer. A prevalence approach was used to estimate current years lived with disability (YLD) because of viral hepatitis contracted years/decades before. We added years of life lost (YLL) to obtain DALYs. Around 76,000 DALYs were attributed to hepatitis C virus (HCV) and 15,323 to hepatitis B virus (HBV) when calculated without applying social values. Applying the discount rate and age-weighting used in the Global Burden Disease study, the BoD nearly halved. In any case, the burden related to hepatitis C including long-term outputs becomes the leading cause of DALYs among transmissible diseases in Spain. The mortality component (YLL) represents more than 90% of the BoD in both HCV and HBV. The findings emphasize the need to provide good surveillance systems not only concerning acute viral hepatitis, but also chronic and end-stage consequences to allow a reliable assessment of the prevention and public health control policies.     

Burden of diabetes mellitus attributable to demographic levels in Qatar: An emerging public health problem

BackgroundDiabetes is one of the main contributors to ill health and premature mortality worldwide and its prevalence has been rising during the last decades.AimThe aim of the present study was to quantify the burden of disease in terms of deaths and loss of healthy life years (DALYs) attributed to diabetes by its demographic levels in the State of Qatar.Materials and methodsThe methods were largely based on the established Global Burden of Disease methodology and use the burden of disease in terms of disability adjusted life years (DALYs) and the years lost due to disability (YLD) as the outcome measure. We calculated years lost due to disability (YLD) and years life lost (YLL) attributable to diabetes. The study was conducted during the period from June 2013 to January 2014.ResultsThe study findings revealed that disability adjusted life years (DALYs) has been increasing across the years and reached to 4.35 in 2011 from 2.58 in 2007. DALYs for men was remarkably higher than women during the period (2007–2011). Diabetes mellitus was the 6th leading cause of disease burden in Qatar (3.8%). The YLD showed a sharp increase in men (2.52 in 2011 from 1.34 in 2007) and women (1.05 in 2011 from 0.33 in 2007) during the year 2011. YLL portion of women enlarged considerably in 2011 (0.10) compared to 2010 (0.04). YLL for men and women was fluctuating across the years with a decrease in 2011 (18%) from 2007 (35%). Men and women in the age group 30–44 years had the highest peak across the years.ConclusionThe study findings revealed that diabetes disease burden was considerably high in Qatar, particularly in the working age group. DALYs has been increasing across the years.     

MORBIDITY AND MORTALITY DUE TO AIDS: A STUDY OF BURDEN OF DISEASE AT A MUNICIPAL LEVEL

Introduction:

The purpose of measuring the burden of disease involves aggregating morbidity and mortality components into a single indicator, the disability-adjusted life year (DALY), to measure how much and how people live and suffer the impact of a disease.

Objective:

To estimate the global burden of disease due to AIDS in a municipality of southern Brazil.

Methods:

An ecological study was conducted in 2009 to examine the incidence and AIDS-related deaths among the population residing in the city of Tubarao, Santa Catarina State, Brazil. Data from the Mortality Information System in the National Health System was used to calculate the years of life lost (YLL) due to premature mortality. The calculation was based on the difference between a standardized life expectancy and age at death, with a discount rate of 3% per year. Data from the Information System for Notifiable Diseases were used to calculate the years lived with disability (YLD). The DALY was estimated by the sum of YLL and YLD. Indicator rates were estimated per 100,000 inhabitants, distributed by age and gender.

Results:

A total of 131 records were examined, and a 572.5 DALYs were estimated, which generated a rate of 593.1 DALYs/100,000 inhabitants. The rate among men amounted to 780.7 DALYs/100,000, whereas among women the rate was 417.1 DALYs/100,000. The most affected age groups were 30-44 years for men and 60-69 years for women.

Conclusion:

The burden of disease due to AIDS in the city of Tubarao was relatively high when considering the global trend. The mortality component accounted for more than 90% of the burden of disease.     

The global impact of hepatic fibrosis and end-stage liver disease

Hepatic fibrosis is an integral part in the progression of chronic liver disease, ultimately leading to cirrhosis and hepatocellular carcinoma. Globally, alcohol consumption, hepatitis B (HBV) and hepatitis C (HCV) have been the main causes of cirrhosis. More recently, the increasing prevalence of obesity and the metabolic syndrome has resulted in increasing incidence of cirrhosis secondary to nonalcoholic fatty liver disease (NAFLD), especially in developed countries. Chronic liver disease and cirrhosis are important causes of morbidity and mortality in the world. Moreover, the burden of chronic liver disease is projected to increase, due in part to the increasing prevalence of end-stage liver disease and HCC secondary to NAFLD and HCV.     

Variations in Ischemic Heart Disease Burden by Age,Country, and Income: The Global Burden of Diseases,Injuries, and Risk Factors 2010 Study

BackgroundIschemic heart disease (IHD) was the leading cause of disease burden worldwide in 2010. The majority of IHD burden affected middle-income regions. We hypothesized IHD burden may vary among countries, even within the same broad geographic region.MethodsDisability-adjusted life years (DALYs) due to IHD were estimated at the region level for 7 “super-regions,” 21 regions, and 187 countries using geographically nested models for IHD mortality and prevalent nonfatal IHD (nonfatal acute myocardial infarction, angina pectoris, or ischemic heart failure). Acute myocardial infarction, angina, and heart failure disability weights were applied to prevalent cases. Absolute numbers of DALYs and age-standardized DALYs per 100,000 persons were estimated for each region and country in 1990 and 2010. IHD burden for world regions was analyzed by country, income, and age.ResultsAbout two-thirds of 2010 IHD DALYs affected middle-income countries. In the North Africa/Middle East and South Asia regions, which have high IHD burden, more than 29% of men and 24% of women struck by IHD were <50 years old. Age-standardized IHD DALYs decreased in most countries between 1990 and 2010, but increased in a number of countries in the Eastern Europe/Central Asia region (>1,000 per 100,000 increase) and South Asia region (>175 per 100,000). Age-standardized DALYs varied by up to 8-fold among countries, by about 9,000 per 100,000 among middle-income countries, about 7,400 among low-income countries, and about 4,300 among high-income countries.ConclusionsThe majority of IHD burden in 2010 affected middle-income regions, where younger adults were more likely to develop IHD in regions such as South Asia and North Africa/Middle East. However, IHD burden varied substantially by country within regions, especially among middle-income countries. A global or regional approach to IHD prevention will not be sufficient; research and policy should focus on the highest burden countries within regions.     

Trends in the Burden of Hepatitis B in a Southern Brazilian State

Background:

Viral hepatitis is a major health problem in Brazil and worldwide. The state of Santa Catarina has high endemic areas, and the disease burden is unknown.

Objectives:

To estimate and analyze the burden of hepatitis B in the state of Santa Catarina, in 2005 - 2010.

Materials and Methods:

A time-series analysis was conducted using notification data of incidence and mortality rates from hepatitis B. The Disability-Adjusted Life Years (DALY) and the components Years of Life Lost (YLL) and Years Lived with Disability (YLD) were calculated. The annual variation was estimated using segmented linear regression, identifying the points at which there were changes in the trend.

Results:

The state of Santa Catarina showed an increase of 11.9% (95% CI 0.9, 24.2) per year in YLL rates. A significant increase was observed for men and within the 70 - 79 age group. There was a significant decrease of -9.4% (95% CI -16.1, -2.2) in the YLD rates per year. The decline was significant for women and within the 15-34 age group. Regarding the DALY rates, the state of Santa Catarina showed a decline of -6.6% (95% CI: -11.0, -2.0) per year. Significant decreases occurred for females and within the 15 - 29 and 45 - 59 age groups. However, there was a significant increase within the 70 - 79 age range.

Conclusions:

The state of Santa Catarina has reduced the disease burden rates attributed to disability from hepatitis B, but there has been an increase in the burden of premature mortality from 2005 to 2010.     

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.     

Burden of diabetes,hyperglycaemia in China from to 2016: Findings from the 1990 to 2016, global burden of disease study

AimsThe prevalence of diabetes in China is among the highest in the world. For this reason, findings from the 2016 Global Burden of Disease (GBD) study were used to calculate the burden of hyperglycaemia and diabetes in China.MethodsFollowing the general analytical strategy used in GBD 2016, diabetes prevalence and mortality were analyzed by age and gender. Trends in disability-adjusted life years (DALYs) due to diabetes were assessed in 33 province-level administrative units from 1990 to 2016, and similar data were provided for chronic kidney disease (CKD) related to diabetes and, as an overall summarizing measure, for hyperglycaemia expressed as high fasting plasma glucose (HFPG).ResultsFrom 1990 to 2016, all-age prevalence of diabetes rose from 3.7% to 6.6%, and all-age diabetes and diabetes-related CKD mortality rates increased by 63.5% and 33.3%, respectively, with both rates increasing more rapidly in diabetes patients aged 15–49 years than in any other age groups. In 2016, HFPG became China's sixth leading cause of DALYs, and the attributable DALYs burden was 1802.3/100,000 population. Although the number of diabetes DALYs increased by 95% from 1990 to 2016, age-standardized diabetes DALYs rates increased by only 2.3%. Also, from 1990 to 2016, rates of age-standardized DALYs due to diabetes decreased in 14 provinces, but increased in 19 provinces. High BMI Scores and diets low in whole grains, nuts and seeds were the most important risk factors for diabetes in 2016.ConclusionDiabetes and hyperglycaemia constitute a huge health burden in China. The substantial increase in diabetes-related burden represents an ongoing challenge, given the rapidly ageing Chinese population. Thus, a targeted control and preventative strategy needs to be developed at risk factor level to reduce this burden.     

Burden of chronic diseases in the Palestinian health-care sector using disability-adjusted life-years

Background

Chronic diseases are the greatest public health concern worldwide, contribute to a large burden of disease in the developed world, and are increasing rapidly in prevalence in developing countries. The aim of this study was to quantify the burden of reported chronic diseases in the occupied Palestinian territory.

Alcohol consumption and non-communicable diseases: epidemiology and policy implications

Aims This paper summarizes the relationships between different patterns of alcohol consumption and various on non‐communicable disease (NCD) outcomes and estimates the percentage of NCD burden that is attributable to alcohol. Methods A narrative review, based on published meta‐analyses of alcohol consumption‐disease relations, together with an examination of the Comparative Risk Assessment estimates applied to the latest available revision of Global Burden of Disease study. Results Alcohol is causally linked (to varying degrees) to eight different cancers, with the risk increasing with the volume consumed. Similarly, alcohol use is related detrimentally to many cardiovascular outcomes, including hypertension, haemorrhagic stroke and atrial fibrillation. For other cardiovascular outcomes the relationship is more complex. Alcohol is furthermore linked to various forms of liver disease (particularly with fatty liver, alcoholic hepatitis and cirrhosis) and pancreatitis. For diabetes the relationship is also complex. Conservatively, of the global NCD‐related burden of deaths, net years of life lost (YLL) and net disability adjusted life years (DALYs), 3.4%, 5.0% and 2.4%, respectively, can be attributed to alcohol consumption, with the burden being particularly high for cancer and liver cirrhosis. This burden is especially pronounced in countries of the former Soviet Union. Conclusions There is a strong link between alcohol and non‐communicable diseases, particularly cancer, cardiovascular disease, liver disease, pancreatitis and diabetes, and these findings support calls by the World Health Organization to implement evidence‐based strategies to reduce harmful use of alcohol.     

Hepatocellular carcinoma in patients with autoimmune hepatitis

AIM： To evaluate and confirm the low incidence of hepatocellular carcinoma （HCC） in patients with autoimmune hepatitis （AIH）. At present only very few cases of HCC in patients with AIH and definite exclusion of chronic viral hepatitis have been published, suggesting that HCC due to AIH is rare. METHODS： In order to further investigate the incidence of HCC in patients with AIH, we reviewed our large cohort of 278 patients with AIH. RESULTS： Eighty-nine patients （32%） were diagnosed with liver cirrhosis, a preneoplastic condition for HCC. We studied a total of 431 patient years of cirrhosis in these patients, an average 4.8 years per patient. During this period none of the patients of our own study cohort developed HCC. However, three patients with HCC due to AIH associated liver cirrhosis were referred to our department for further treatment of HCC. In all three patients chronic viral hepatitis was excluded. CONCLUSION： We conclude that HCC may under rare circumstances develop due to chronic AIH dependent liver cirrhosis. Compared to other causes of liver cirrhosis such as chronic viral hepatitis, alcohol, or hemochromatosis, the incidence of HCC is significantly lower. Pathophysiological differences between AIH and chronic viral hepatitis responsible for differences in the incidence of HCC are yet to be further characterized and may lead to new therapeutic concepts in prevention and treatment of liver cancer.     

The Burden of Disease and the Cost of Illness Attributable to Alcohol Drinking—Results of a National Study

Background and Aims: The World Health Organization estimated that 3.2% of the burden of disease around the world is attributable to the consumption of alcohol. The aim of this study is to estimate the burden of disease attributable to alcohol consumption in Portugal. Methods: Burden and costs of diseases attributable to alcohol drinking were estimated based on demographic and health statistics available for 2005, using the Disability‐Adjusted Life Years (DALY) lost generated by death or disability. Results: In Portugal, 3.8% of deaths are attributable to alcohol (4,059 of 107,839). After measuring the DALY generated by mortality data, the proportion of disease attributable to alcohol was 5.0%, with men having 5.6% of deaths and 6.2% of disease burden, while female figures were, respectively, 1.8 and 2.4%. Considering the sum of death and disability DALYs, liver diseases represented the main source of the burden attributable to alcohol with 31.5% of total DALYs, followed by traffic accidents (28.2%) and several types of cancer (19.2%). As for the cost of illness incurred by the health system, our results indicate that €95.1 millions are attributable to alcohol‐related disease admissions (liver diseases, cancer, traffic accidents, and external causes) while the ambulatory costs of alcohol‐related diseases were estimated in €95.9 million, totaling €191.0 million direct costs, representing 0.13% of Gross Domestic Product and 1.25% of total national health expenditures. An alternative analysis was carried out using higher consumption levels so as to replicate aggregate alcohol consumption statistics. In this case, DALYs lost increased by 11.7% and health costs by 23%. Conclusion: Our results confirm that alcohol is an important health risk factor in Portugal and a heavy economic burden for the health system, with hepatic diseases ranking first as a source of burden of disease attributable to alcohol.     

Global and Regional Burden of Death and Disability From Peripheral Artery Disease: 21 World Regions, 1990 to 2010

A comprehensive and systematic assessment of disability and mortality due to lower extremity peripheral artery disease (PAD) is lacking. Therefore, we estimated PAD deaths, disability-adjusted life years (DALYs), and years of life lost in 21 regions worldwide for 1990 and 2010. We used the GBD (Global Burden of Diseases 2010) study causes of death database, and the cause of death ensemble modeling approach to assess levels and trends of PAD deaths and years of life lost over time, by age, sex, and region. Assessment of DALYs employed estimates of PAD prevalence from systematic reviews of epidemiologic data using a Bayesian meta-regression method. In 1990, the age-specific PAD death rate per 100,000 population ranged from 0.05 (95% confidence interval [CI]: 0.03 to 0.09) among those 40 to 44 years old to 16.63 (95% CI: 10.47 to 25.31) among the 80+ years group. In 2010, the corresponding estimates were 0.07 (95% CI: 0.04 to 0.13) and 28.71 (95% CI: 18.3 to 43.06). Death rates increased consistently with age in 1990 and 2010, and the rates in 2010 were higher than they were in 1990 in all age categories. The largest relative change in median death rate of +6.03 per 100,000 (95% CI: 1.50 to 11.85) was noted in the Asia Pacific–High Income region and was largely driven by higher rates in women: +17.36 (95% CI: 1.79 to 32.01) versus +1.25 (95% CI: 0.13 to 2.39) in men. The overall relative change in median DALYs was larger in developing nations than in developed nations: 1.15 (95% CI: 0.80 to 1.66) versus 0.77 (95% CI: 0.55 to 1.08). Of note, the overall relative change in median DALYs was higher among both men and women in developing versus developed countries: men: 1.18 (95% CI: 0.82 to 1.65) versus 0.51 (95% CI: 0.30 to 0.81), and women: 1.11 (95% CI: 0.58 to 2.02) versus 1 (95% CI: 0.67 to 1.47). Within developed nations, the overall relative change in median DALY rates was larger in women than in men: +1.00 (95% CI: 0.67 to 1.47) versus +0.51 (95% CI: 0.3 to 0.81). Similarly, the overall relative change in median years of life lost rate in developed countries was larger in women than in men: +1.64 (95% CI: 1.17 to 2.34) versus +0.53 (95% CI: 0.24 to 0.94). The relative increases in median years lived with nonfatal disease disability (YLD) rates in men and women were larger in developing versus developed nations: men: 0.87 (95% CI: 0.59 to 1.2) versus 0.49 (95% CI: 0.29 to 0.73), and women: 0.75 (95% CI: 0.46 to 1.09) versus 0.49 (95% CI: 0.29 to 0.73). Disability and mortality associated with PAD has increased over the last 20 years, and this increase in burden has been greater among women than among men. In addition, the burden of PAD is no longer confined to the elderly population, but now involves young adults. Furthermore, the relative increase in PAD burden in developing regions of the world is striking and exceeds the increases in developed nations.     

Incidence,prevalence, and causes of death of patients with autoimmune hepatitis: A nationwide register-based cohort study in Finland

BackgroundEpidemiological studies of autoimmune hepatitis are scarce and often based on single centre registries.AimsWe conducted a nationwide register study of incidence, prevalence, survival, and causes of death of autoimmune hepatitis patients in Finland.MethodsAutoimmune hepatitis cases 1995–2015 were retrieved from the national database of special reimbursements for drugs costs. Data on causes of death were retrieved from Statistics Finland.ResultsAfter incomplete registration of AIH during the first years, the incidence of autoimmune hepatitis stabilised to 1.1/100,000 person-years (1.6 in women and 0.52 in men) in 2008–2015. The prevalence of autoimmune hepatitis at the end of 2015 was 14.3/100,000, 23.0/100,000 in women and 6.6/100,000 in men. The all-cause standardized mortality ratio (SMR) of autoimmune hepatitis patients was 1.81 (95% confidence interval (CI) 1.47–2.20). The SMR was increased in all age groups and in both sexes. The SMR for hepatocellular carcinoma was 20.6 (95% CI 10.3–36.8), and for digestive diseases in overall 13.5 (95% CI 8.2–20.8), constituting mainly from autoimmune hepatitis and liver cirrhosis.ConclusionIncidence of autoimmune hepatitis has remained stable, with clear female predominance. Autoimmune hepatitis is associated with a markedly increased risk of death with hepatocellular cancer forming the greatest risk.     

Long-term management of alcoholic liver disease

Despite the epidemics of viral hepatitis C and nonalcoholic fatty liver disease, alcohol remains one of the major causes of liver disease. Commonly, hepatitis C and other liver diseases are found in association with alcohol consumption. This association in many instances is noted to accelerate the progression of liver disease. In many respects, the long-term management of alcoholic liver disease is not dissimilar from the long-term management of patients with cirrhosis from other etiologies. One major element is the abstinence of alcohol use. The ability to maintain sobriety has a major impact on the outcome of patients with alcoholic cirrhosis because maintaining abstinence can lead to significant regression of fibrosis and possibly early cirrhosis. Similarities in managing patients with cirrhosis due to alcohol or cirrhosis from other causes include vaccination to prevent superimposed viral hepatitis and screening for esophageal varices and hepatocellular carcinoma with subsequent appropriate therapy.     

The burden of disease due to tuberculosis in the state of Santa Catarina,Brazil,

OBJECTIVE:

To estimate the burden of disease due to tuberculosis in the state of Santa Catarina, Brazil, in 2009.

METHODS:

This was an epidemiological study with an ecological design. Data on tuberculosis incidence and mortality were collected from specific Brazilian National Ministry of Health databases. The burden of disease due to tuberculosis was based on the calculation of disability-adjusted life years (DALYs). The DALYs were estimated by adding the years of life lost (YLLs) and years lived with disability (YLDs). Absolute values were transformed into rates per 100,000 population. The rates were calculated by gender, age group, and health care macroregion.

RESULTS:

The burden of disease due to tuberculosis was 5,644.27 DALYs (92.25 DALYs/100,000 population), YLLs and YLDs respectively accounting for 78.77% and 21.23% of that total. The highest rates were found in males in the 30-44 and 45-59 year age brackets, although that was not true in every health care macroregion. Overall, the highest estimated burden was in the Planalto Norte macroregion (179.56 DALYs/100,000 population), followed by the Nordeste macroregion (167.07 DALYs/100,000 population).

CONCLUSIONS:

In the majority of the health care macroregions of Santa Catarina, the burden of disease due to tuberculosis was concentrated in adult males, the level of that concentration varying among the various macroregions.     

Pathophysiology of insulin resistance and steatosis in patients with chronic viral hepatitis

Chronic hepatitis due to any cause leads to cirrhosis and end-stage liver disease.A growing body of literature has also shown that fatty liver due to overweight or obesity is a leading cause of cirrhosis.Due to the obesity epidemic,fatty liver is now a significant problem in clinical practice.Steatosis has an impact on the acceleration of liver damage in patients with chronic hepatitis due to other causes.An association between hepatitis C virus (HCV) infection,steatosis and the onset of insulin resistance ...     

Mortality landscape in the Global Burden of Diseases,Injuries and Risk Factors Study

The Global Burden of Diseases, Injuries and Risk Factors Study 2010 (GBD 2010) is an initiative that involved 486 scientists from 302 institutions in 50 countries, under the leadership of a consortium formed by the Institute for Health Metrics and Evaluation of the University of Washington, World Health Organization, the University of Queensland School of Population Health, the Harvard School of Public Health, the Johns Hopkins Bloomberg School of Public Health, the University of Tokyo and Imperial College London. The study has provided a state of the art understanding of the burden of 67 risk factors and their clusters, 291 diseases and injuries on global, regional and national levels in period from 1990 to 2010 for 187 countries. GBD 2010 estimates covered both mortality (expressed in number of deaths, years of life lost (YLL) due to premature mortality) and morbidity (mainly expressed as years lived with disability (YLD)), while the incidence and prevalence were not reported for majority of causes so far, although they were accounted and used for YLD calculations. Finally, each disease and risk factor was presented in terms of the disability-adjusted years of life (DALY) that is merely a sum of YLL and YLD. The major published results of GBD 2010 cover global and regional levels for all diseases and risk factors. Reports focused on specific conditions are also available. At country-level detailed estimates are published for UK, China and USA, and data on other countries are accessible only as aggregate partial representation via web-based tools.     

Chronic hepatitis induced by alcohol

Fifteen heavy drinkers with the histological features of chronic hepatitis were studied. Chronic hepatitis observed in heavy drinkers can be divided into two categories. One is caused by alcohol, and the other is not etiologically related to alcohol. Chronic hepatitis caused by alcohol showed a definite improvement of clinical features following abstinence, as well as significantly high serum GOT/GPT ratios and high glutamate dehydrogenase activities on admission. These clinical features are distinctly different from chronic hepatitis without etiological relation to alcohol and resemble the other types of alcoholic liver injury. The leukocyte migration inhibition test by ethanol was more frequently positive in chronic hepatitis induced by alcohol than in the other types of alcoholic liver injury except for alcoholic hepatitis. Histological characteristics of the liver in chronic hepatitis induced by alcohol included the coexistence of features of both chronic hepatitis and alcoholic fibrosis. Three of four cases of chronic hepatitis induced by alcohol developed cirrhosis during the follow-up period. These results suggest that chronic hepatitis induced by alcohol is a type of alcoholic liver disease with an immunopathological etiology. It is a step toward the development of liver cirrhosis.