Ideology, history and changing models of liver cirrhosis epidemiology.

This analysis describes changes in assumptions about beverage alcohol use as a major cause of liver cirrhosis since the turn of the century. The findings reveal that social and political views shaped by the temperance movement, Repeal era and modern alcoholism movement have had a profound impact on medical and public health interpretations of the role of alcohol use in liver disease. Current clinical and epidemiological approaches that stress the importance of alcohol as a direct etiological agent for liver cirrhosis were popular during the 19th century in the wake of the temperance and prohibition movements, but were greatly modified to attribute a secondary role to alcohol use as a cause of cirrhosis during the Repeal and post-World War II eras. The changes during the Repeal and post-World War II eras coincided with the expansion of alcohol consumption and the liberalization of drinking norms in US society. As a result, the role of alcohol in causing cirrhosis among the general population was minimized and the disease was attributed to industrial toxins and air pollution. Contemporary research has affirmed the importance of beverage alcohol as a causal agent of liver cirrhosis using both clinical and epidemiological studies.