Influence of comorbidities on health-related quality of life in alcohol-related liver disease: a population-based survey

Abstract

Extra-hepatic 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. Patients with ALD and matched comparators were identified among respondents of the Danish National Health Surveys 2010-2017. Survey data included generic measures of physical and mental HRQoL (12-item Short Form), comorbidities, alcohol and smoking. Low HRQoL in ALD was defined as >1.5 standard deviations worse than the average HRQoL in the comparators. Odds ratios (OR) of low HRQoL was estimated with multivariable logistic regression adjusting for potential confounders. 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 (COPD) (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% CI: 1.54-3.05)] and low mental HRQoL [OR 1.91 (95%CI: 1.27-2.88)]. For lifestyle factors, drinking > 20 units/week was associated with low physical and smoking > 20 cigarettes/day with low mental HRQoL, when compared to abstainers and non-smokers, respectively. Common comorbidities including COPD, musculoskeletal and psychiatric disease are associated with low HRQoL in ALD, independently of liver disease severity, and so are alcohol consumption and smoking. These findings highlight the importance of multidisciplinary management of patients with ALD.