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Comment & Response
September 10, 2019

Trends in Alcoholic Fatty Liver Disease

Author Affiliations
  • 1Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan, China
  • 2Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Piscataway, New Jersey
  • 3Department of Biological Sciences, Rutgers University, Newark, New Jersey
JAMA. 2019;322(10):979-980. doi:10.1001/jama.2019.10347

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.