Title: Global, regional, and national burden of cirrhosis and other chronic liver diseases due to
alcohol use, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Version: 2 Date: 30 Jul 2022
Reviewer's report:
The manuscript needs a thorough copy-editing of English.  Several parts may be misunderstood
based on language.
1) The biggest problem of the study is that is assumes linear trends.  However, in many countries,
such as Lithuania, which they highlight, the trends are not linear.
There alcoholic LC rates increased starkly until 2007 and then dropped by about 40%.  The
linear estimation used is problematic for such developments.  This must be acknowledged as
the major point in the limitations.
2) The uncertainty intervals for the main statistics like yearly change are severely
underestimated, as they disregard the uncertainty of the underlying GBD estimates.  This
limitation needs to be acknowledged.
3) At several points in the text, the authors argue with Liver cancer.  However, this is NOT part
of the the category they examine!
4) There are quite a lot of inconsistencies in the manuscript.  I just list two:
"Finally, we only revealed the death rate and the number of DALYs, as the incidence and
prevalence of alcohol-related cirrhosis and other chronic liver diseases were not revealed in
GBD 2019."
This sentence in the limitation section makes no sense.  It is factually incorrect, as GBD gives
incidence and prevalence.  Moreover, in their Table 1, they show incidence.
"In the past 30 years, the age-standardized rate of mortality and number of DALYs have
declined, partly because some countries, especially those in high-SDI regions, have adopted
preventive measures, such as pricing policies, in the past few decades [6]. However, the global
age-standardized incidence of these diseases is increasing. "
First, the overall GDB results are not that much impacted by trends in HIC.  The global trends are
way more impacted by trends in China and India....  Second, pricing policies have been sparely
used in HIC according the WHO.  Third, how could - assuming there had been pricing policies
- pricing policies decrease mortality and DALYs when incidence had been increasing.
In sum, this text needs a thorough revision.  Inconsistencies should be removed and the English
needs improvement.
Title: Global, regional, and national burden of cirrhosis and other chronic liver diseases due to
alcohol use, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Version: 2 Date: 30 Jul 2022
Reviewer's report:
The manuscript needs a thorough copy-editing of English.  Several parts may be misunderstood
based on language.
1) The biggest problem of the study is that is assumes linear trends.  However, in many countries,
such as Lithuania, which they highlight, the trends are not linear.
There alcoholic LC rates increased starkly until 2007 and then dropped by about 40%.  The
linear estimation used is problematic for such developments.  This must be acknowledged as
the major point in the limitations.
2) The uncertainty intervals for the main statistics like yearly change are severely
underestimated, as they disregard the uncertainty of the underlying GBD estimates.  This
limitation needs to be acknowledged.
3) At several points in the text, the authors argue with Liver cancer.  However, this is NOT part
of the the category they examine!
4) There are quite a lot of inconsistencies in the manuscript.  I just list two:
"Finally, we only revealed the death rate and the number of DALYs, as the incidence and
prevalence of alcohol-related cirrhosis and other chronic liver diseases were not revealed in
GBD 2019."
This sentence in the limitation section makes no sense.  It is factually incorrect, as GBD gives
incidence and prevalence.  Moreover, in their Table 1, they show incidence.
"In the past 30 years, the age-standardized rate of mortality and number of DALYs have
declined, partly because some countries, especially those in high-SDI regions, have adopted
preventive measures, such as pricing policies, in the past few decades [6]. However, the global
age-standardized incidence of these diseases is increasing. "
First, the overall GDB results are not that much impacted by trends in HIC.  The global trends are
way more impacted by trends in China and India....  Second, pricing policies have been sparely
used in HIC according the WHO.  Third, how could - assuming there had been pricing policies
- pricing policies decrease mortality and DALYs when incidence had been increasing.
In sum, this text needs a thorough revision.  Inconsistencies should be removed and the English
needs improvement.
Please review this paper.
user
Title: Global, regional, and national burden of cirrhosis and other chronic liver diseases due to
alcohol use, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Version: 2 Date: 30 Jul 2022
Reviewer's report:
The manuscript needs a thorough copy-editing of English.  Several parts may be misunderstood
based on language.
1) The biggest problem of the study is that is assumes linear trends.  However, in many countries,
such as Lithuania, which they highlight, the trends are not linear.
There alcoholic LC rates increased starkly until 2007 and then dropped by about 40%.  The
linear estimation used is problematic for such developments.  This must be acknowledged as
the major point in the limitations.
2) The uncertainty intervals for the main statistics like yearly change are severely
underestimated, as they disregard the uncertainty of the underlying GBD estimates.  This
limitation needs to be acknowledged.
3) At several points in the text, the authors argue with Liver cancer.  However, this is NOT part
of the the category they examine!
4) There are quite a lot of inconsistencies in the manuscript.  I just list two:
"Finally, we only revealed the death rate and the number of DALYs, as the incidence and
prevalence of alcohol-related cirrhosis and other chronic liver diseases were not revealed in
GBD 2019."
This sentence in the limitation section makes no sense.  It is factually incorrect, as GBD gives
incidence and prevalence.  Moreover, in their Table 1, they show incidence.
"In the past 30 years, the age-standardized rate of mortality and number of DALYs have
declined, partly because some countries, especially those in high-SDI regions, have adopted
preventive measures, such as pricing policies, in the past few decades [6]. However, the global
age-standardized incidence of these diseases is increasing. "
First, the overall GDB results are not that much impacted by trends in HIC.  The global trends are
way more impacted by trends in China and India....  Second, pricing policies have been sparely
used in HIC according the WHO.  Third, how could - assuming there had been pricing policies
- pricing policies decrease mortality and DALYs when incidence had been increasing.
In sum, this text needs a thorough revision.  Inconsistencies should be removed and the English
needs improvement.
assistant