Adverse health outcomes in offspring of parents with alcohol-related liver disease: Nationwide Danish cohort study.

Background: Parental drinking can cause harm to the offspring. A parent's diagnosis of alcohol-related liver disease (ALD) might be an opportunity to reach offspring with preventive interventions. We investigated offspring risk of adverse health outcomes throughout life, their association with their parent's educational level and diagnosis of ALD. Methods and findings: We used nationwide health registries to identify offspring of parents diagnosed with ALD in Denmark 1996 to 2018 and age- and sex-matched comparators (20:1). We estimated the incidence rate ratios (IRRs) of hospital contacts with adverse health outcomes, overall and in socioeconomic strata. We used a self-controlled design to examine whether health outcomes were more likely to occur during the first year after the parent's ALD diagnosis. The 60,804 offspring of parents with ALD had a higher incidence rate of hospital contacts from age 15 to 60 years for psychiatric disease, poisoning, fracture or injury, alcohol-specific diagnoses, other substance abuse, and of death than comparators. Associations were stronger for offspring with low compared to high socioeconomic position: The IRR for admission due to poisoning was 2.2 versus 1.0 for offspring of an ALD parent with a primary level versus a highly educated ALD parent. Offspring had an increased risk for admission with psychiatric disease and poisoning in the year after their parent's ALD diagnosis. For example, among offspring whose first hospital contact with psychiatric disease was at age 13 to 25 years, the IRR in the first year after their parent's ALD diagnosis versus at another time was 1.29 (95% CI 1.13, 1.47). Main limitation was inability to include adverse health outcomes not involving hospital contact. Conclusions: Offspring of parents with ALD had a long-lasting higher rate of health outcomes associated with poor mental health and self-harm that increased shortly after their parent's diagnosis of ALD. Offspring of parents of low educational level were particularly vulnerable. This study highlights an opportunity to reach out to offspring in connection with their parent's hospitalization with ALD. Leveraging registry data, Peter Jepsen and colleagues explore the risk of adverse health outcomes among offspring and associations with diagnosis of alcohol-related liver disease of one or both parents and parents' education level. Author summary: Why was this study done?: Young offspring of parents with alcohol use disorder have higher rates of poor mental health, and substance misuse and many of them have not received professional help in relation to their parent's alcohol misuse. It has not been investigated whether these higher rates of adverse health outcomes continue throughout adulthood are influenced by their parent's diagnosis of alcohol-related liver disease (ALD) and the influence of parental socioeconomic position has not been thoroughly investigated. The temporal relationship between a parent's diagnosis of ALD and an offspring's adverse health outcomes may show us an opportune time to offer support to the offspring in the clinical setting, hopefully preventing future adverse outcomes. What did the researchers do and find?: This was an exploratory study of adverse health outcomes in 60,804 offspring of patients with ALD compared to 1.2 million matched controls, based on Danish nationwide health registries 1996 to 2018. Offspring of 15 to 60 years had higher rates of hospital contacts due to psychiatric disease, poisoning, fracture or injury, alcohol-specific diagnoses, other substance abuse, and of death than comparators had. Offspring of parents of low compared to higher educational level had the highest rates of hospital contacts. In the year after the parent's diagnosis of ALD, offspring experienced an increase in hospitalization due to outcomes associated with self-harm (e.g., poisoning) and poor mental health (e.g., psychiatric disease). What do these findings mean?: Preventive interventions are needed to help offspring of parents with alcohol use disorder, and a parent's hospital admission for ALD is a window of opportunity for healthcare professionals to reach out. The main study limitation was inability to include adverse health outcomes not involving hospital contacts leading to an underestimated burden of adverse health outcomes in offspring of parents with ALD. [ABSTRACT FROM AUTHOR]