To the Editor Dr Wong and colleagues1 reported trends in the prevalence of alcoholic fatty liver disease (AFLD). We raise some methodological considerations.
First, age standardization is desired in epidemiologic analyses of trends over a long period. The authors conducted sensitivity and subgroup analyses by age group. However, the overall prevalence was not standardized by age and may be subject to bias introduced by changes in age distribution through the years. The proportions of patients aged 20 to 44 years increased from 5.6% in 2001-2002 to 6.5% in 2015-2016; the proportion 65 years or older increased from 1.0% to 4.2%. Thus, trend analyses on age-standardized prevalence appear warranted.
Zhang J, Lin Y, Zhang L. Trends in Alcoholic Fatty Liver Disease. JAMA. 2019;322(10):979–980. doi:10.1001/jama.2019.10347
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