European Journal of Epidemiology

, Volume 14, Issue 5, pp 447–456 | Cite as

Exploring the combined action of lifetime alcohol intake and chronic hepatotropic virus infections on the risk of symptomatic liver cirrhosis

  • Giovanni Corrao
  • Pierfederico Torchio
  • Antonella Zambon
  • Pieralda Ferrari
  • Sarino Aricò
  • Ferdinando di Orio


Although alcohol intake and hepatitis B and C virus (HBV and HCV) infections are the major determinants of liver cirrhosis (LC) in western countries, the joint effect of these factors on LC risk has not yet been adequately studied. Data from three case-control studies performed in Italy were used. Cases were 462 cirrhotic patients admitted to Hospitals for liver decompensation. Controls were 651 inpatients admitted for acute diseases unrelated to alcohol. Alcohol consumption was expressed as lifetime daily alcohol intake (LDAI). Three approaches were used to explore the interaction structure. The Breslow and Storer parametric family of relative risk functions showed that an intermediate structure of interaction from additive to multiplicative was the most adequate one. The Rothman synergism index showed that the interaction structure between LDAI and viral status differed significantly from the additive model in particular for high levels of alcohol intake. When multiple regression additive and multiplicative models were compared after adjustment for the known confounding variables, a trend of the interaction structure towards the multiplicative model was observed at increasing levels of consumption. Better methods are needed for assessing mixed interaction structures in conditions characterized by multifactorial etiologies like cirrhosis of the liver.

Additive model Alcohol intake Case-control Hepatitis B virus Hepatitis C virus Interaction Liver cirrhosis Multiplicative model Relative risk Synergism 


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Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Giovanni Corrao
    • 1
  • Pierfederico Torchio
    • 1
  • Antonella Zambon
    • 1
  • Pieralda Ferrari
    • 1
  • Sarino Aricò
    • 2
  • Ferdinando di Orio
    • 3
  1. 1.Department of StatisticsUniversity of MilanITALY
  2. 2.Division of GastroenterologyHospital Mauriziano Umberto ITurin
  3. 3.Department of Internal Medicine and Public HealthUniversity of L'AquilaItaly

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