Acta medica portuguesa · 2026
[Alcoholic Liver Disease Hospital Admissions in Portugal: Demographic, Geographic and Temporal Patterns (2013 - 2023)].
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Aniceto Carlos, Sousa-Uva Mafalda, Tato Marinho Rui, Matias-Dias Carlos
Аннотация
INTRODUCTION: Excessive alcohol consumption is a major global public health concern, contributing to injuries, morbidity, disability, and premature mortality. Alcoholic liver disease (ALD), encompassing conditions from steatosis to cirrhosis and hepatocellular carcinoma, represents a substantial proportion of alcohol-related hospital admissions in Portugal. The aim of this study was to describe the temporal, demographic, and geographic patterns of ALD hospital admission episodes in Mainland Portugal between 2013 and 2023.
METHODS: An ecological spatio-temporal study was conducted using hospital admission episode data with ALD as the principal diagnosis, obtained from the hospital morbidity database of the Ministry of Health. Population data were obtained from the National Statistics Institute. Crude rates were calculated by sex and age group, and age-standardized rates were calculated overall and stratified by sex, region, and municipality. Temporal trends were analyzed using negative binomial regression, with results expressed as rate ratios (RR) and 95% confidence intervals (CI). Spatial variation at the municipal level was assessed using Bayesian hierarchical models fitted with Integrated Nested Laplace Approximation.
RESULTS: A total of 37 158 ALD hospital admission episodes were analyzed. Between 2013 and 2023, the average annual age-standardized rate was 37.1 per 100 000 population (66.9 in men and 12.3 in women). A significant decreasing trend in hospital admission episode rates was observed (RR = 0.955; 95% CI: 0.943 - 0.968), corresponding to an average annual reduction of 4.5%, with similar patterns in both sexes. Higher rates were observed among men and in the 55 - 64 age group. Geographically, higher rates and spatial relative risks were generally observed in inland municipalities of the North and Centre regions, while lower values were observed in Alentejo.
CONCLUSION: Despite the overall decline in ALD hospital admission episode rates during the study period, a consistent pattern was observed: higher admission rates among men (55 - 64 years) and in specific inland areas of Mainland Portugal, in agreement with the spatial distribution of relative risks. These findings describe patterns of hospital admission and underscore the need for continuous epidemiological monitoring to support geographically targeted interventions, including prevention of harmful alcohol consumption and improved management of ALD-related hospital admissions.
METHODS: An ecological spatio-temporal study was conducted using hospital admission episode data with ALD as the principal diagnosis, obtained from the hospital morbidity database of the Ministry of Health. Population data were obtained from the National Statistics Institute. Crude rates were calculated by sex and age group, and age-standardized rates were calculated overall and stratified by sex, region, and municipality. Temporal trends were analyzed using negative binomial regression, with results expressed as rate ratios (RR) and 95% confidence intervals (CI). Spatial variation at the municipal level was assessed using Bayesian hierarchical models fitted with Integrated Nested Laplace Approximation.
RESULTS: A total of 37 158 ALD hospital admission episodes were analyzed. Between 2013 and 2023, the average annual age-standardized rate was 37.1 per 100 000 population (66.9 in men and 12.3 in women). A significant decreasing trend in hospital admission episode rates was observed (RR = 0.955; 95% CI: 0.943 - 0.968), corresponding to an average annual reduction of 4.5%, with similar patterns in both sexes. Higher rates were observed among men and in the 55 - 64 age group. Geographically, higher rates and spatial relative risks were generally observed in inland municipalities of the North and Centre regions, while lower values were observed in Alentejo.
CONCLUSION: Despite the overall decline in ALD hospital admission episode rates during the study period, a consistent pattern was observed: higher admission rates among men (55 - 64 years) and in specific inland areas of Mainland Portugal, in agreement with the spatial distribution of relative risks. These findings describe patterns of hospital admission and underscore the need for continuous epidemiological monitoring to support geographically targeted interventions, including prevention of harmful alcohol consumption and improved management of ALD-related hospital admissions.