Estimates of the Global Reduction in Liver Disease-related Mortality With Increased Coffee Consumption

An Analysis of the Global Burden of Disease Dataset

Paul Gow; Tim Spelman; Sarah Gardner; Margaret Hellard; Jessica Howell

Disclosures

Aliment Pharmacol Ther. 2020;52(7):1195-1203. 

In This Article

Results

Per capita coffee consumption data were available for 112 of the 194 countries listed in the GBD dataset (58%) (Table S1; Figure 1). Worldwide, there were an estimated total of 1 240 201 (95% CI 118 4300–1 354 410) deaths due to liver disease in 2016 among people aged > 15 years.[22] The median global liver mortality rate in 2016 was 15 deaths per 100 000 population per year (all ages, both genders; IQR 11–21 deaths per 100 000).

Figure 1.

Global map of estimated per capita daily coffee intake in cups/day. Daily estimated per capita coffee intake (cups/day) is demonstrated for South, Central and North America, Australia and New Zealand, Europe and Scandinavia. All other world regions had estimated per capita daily coffee intake of less than one cup per day

If worldwide per capita coffee was more than two cups per day, the total number of liver-related deaths among those aged > 15 years would reduce to an estimated 714 942 (95% CI 713 811–716 289) in 2016 (best case scenario 451 219 – worst case scenario 914 788 liver-related deaths), translating to an estimated 524 413 deaths averted (95% CI 522 966–525 444 deaths averted) and a population preventable rate of 7.8 liver-related deaths per 100 000 per year.

If all countries increased their per capita coffee intake to four or more cups per day, the total global number of deaths would have been 405 632 (95% CI 403 997–406 476), with a best-case scenario of 227 829 liver-related deaths and a worst-case scenario of 771 794 deaths. 833 725 (95% CI 832 779–835 258) liver-related deaths would have been averted and the population preventable rate would be 12.1 liver-related deaths per 100 000 per year (Table 1 and Table 2; Table S2).

Table 1 and Table 2 illustrate the potential impact in global regions of increased coffee consumption.

Sensitivity Analyses

We used sensitivity analyses to explore some of the limitations in the assumptions used to generate our data. First, we have assumed that countries with no import or export data for coffee have per capita consumption levels of 0–2 cups of coffee per capita per day. We therefore performed a sensitivity analysis where we instead assumed that all countries with no import and export coffee data were drinking more than two cups of coffee daily and would therefore not derive mortality benefit from a population-based increase of coffee consumption to two or more cups of coffee per day (Table S3). Making this assumption, the estimated number of liver-related deaths averted in 2016 by an increase in coffee consumption of more than two cups per capita per day would be 452 861 (95% CI 451 948–454 116) and with four or more cups per capita per day, an estimated 723 287 (95% CI 721 817–723 984) liver-related deaths would be averted.

Some published data suggest that hepatitis B infected people derive less mortality benefit from coffee consumption compared with other aetiologies of chronic liver disease.[14,15,17] To account for this, we performed an additional sensitivity analysis to determine the impact of excluding all hepatitis B- related liver deaths (Table S4 https://onlinelibrary.wiley.com/action/downloadSupplement?doi=10.1111%2Fapt.16020&file=apt16020-sup-0004-TableS4.docx). Taking the conservative assumption that coffee intake does not impact HBV related liver mortality, the global number of non-HBV related liver deaths averted in 2016 if per capita coffee intake increased to more than two cups per day would have been 478 059 deaths averted (95% CI 476 876–479 044 deaths averted) and 761 702 deaths averted (95% CI 760 834–763 002 deaths averted) if coffee consumption increased to four or more cups per day.

Finally, chronic liver disease-related mortality increases with increasing age and some studies suggest that mortality benefits may be less in those aged < 57 years.[25] We therefore restricted our analysis to individuals aged 55–79 years (Table S5). Even when the survival benefits of coffee were restricted to those aged 55–79 years, increasing global coffee consumption to more than two cups, and four or more cups, per capita per day averted an estimated 242 959 deaths (95% CI 241 689–243 857) and 406 863 deaths (95% CI 405 345–407 512), respectively.

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