Mortality from Alcoholic Cardiomyopathy: Exploring the Gap between Estimated and Civil Registry Data

Based on civil registries, 26,000 people died from alcoholic cardiomyopathy (ACM) in 2015 globally. In the Global Burden of Disease (GBD) 2017 study, garbage coded deaths were redistributed to ACM, resulting in substantially higher ACM mortality estimates (96,669 deaths, 95% confidence interval: 82,812-97,507). We aimed to explore the gap between civil registry and GBD mortality data, accounting for alcohol exposure as a cause of ACM.

ACM mortality rates were obtained from civil registries and GBD for n = 77 countries. The relationship between registered and estimated mortality rates was assessed by sex and age groups, using Pearson correlation coefficients, in addition to comparing mortality rates with population alcohol exposure-the underlying cause of ACM.

Among people aged 65 years or older, civil registry mortality rates of ACM decreased markedly whereas GBD mortality rates increased. The widening gap of registered and estimated mortality rates in the elderly is reflected in a decrease of correlations. The age distribution of alcohol exposure is more consistent with the distribution of civil registry rather than GBD mortality rates.

Among older adults, GBD mortality estimates of ACM seem implausible and are inconsistent with alcohol exposure. The garbage code redistribution algorithm should include alcohol exposure for ACM and other alcohol-attributable diseases.