Alcohol-associated liver disease mortality doubled from 1999 to 2022, with pronounced increases among women, younger adults, and American Indian and Alaska Native populations, according to study results published in JAMA Network Open.
Researchers also observed “concerning” and “significant” acceleration during and following the COVID-19 pandemic.
Robert J. Wong
“These findings continue to highlight the alarming trends in unhealthy alcohol use and its downstream complications leading to end-organ damage such as liver disease,” study author Robert J. Wong, MD, MS, FACG, FAASLD, clinical associate professor in the division of gastroenterology and hepatology at Stanford University School of Medicine and staff physician at VA Palo Alto Healthcare System, told Healio.
“These observations, along with other studies, emphasize the need to raise greater awareness of the dangers of unhealthy and excessive alcohol use, the importance of asking about and screening for alcohol use disorder in clinical settings, and ensuring individuals have access to timely resources to help address problematic alcohol use and alcohol use disorder,” he added.
In a retrospective, cross-sectional study, Wong and colleagues evaluated trends in alcohol-associated liver disease (ALD) mortality in the U.S. and District of Columbia from 1999 to 2022 using the CDC Wide-ranging Online Data for Epidemiologic Research database.
Analysis included adults aged 25 years and older.
Age-adjusted annual mortality rates per 100,000 population — grouped by sex, age groups (25-44, 45-64, 65-84, 85 years), race/ethnicity and geographic regions — served as the primary outcome. The researchers used Joinpoint regression to calculate average annual percentage change (APC) and evaluate significance of trends.
Results showed 436,814 ALD deaths (70.7% men) between 1999 and 2022, rising from 6.71 deaths per 100,000 in 1999 to 12.53 deaths per 100,000 in 2022.
The researchers noted “significant acceleration” between 2018 and 2022 (APC = 8.94%; 95% CI, 6.27%-14.51%), coinciding with the onset of the COVID-19 pandemic.
Increases in ALD mortality were more rapid among women than men (average APC = 4.29% vs. 2.5%). Adults aged 25 to 44 years also demonstrated a “concerning” increase (average APC = 4.23%; 95% CI, 3.47%-4.83%).
The highest mortality rates were observed among American Indian and Alaska Native populations, with an increase from 25.21 deaths per 100,000 in 1999 to 46.75 deaths per 100,000 in 2022 (average APC = 4.93%; 95% CI, 3.45%-5.96%).
Mortality from alcohol-associated hepatitis increased from 0.47 per 100,000 in 1999 to 0.76 deaths per 100,000 in 2022 (average APC = 2.08%; 95% CI, 1.27%-3.05%), with women exhibiting more pronounced increases (average APC = 3.94%; 95% CI, 2.58%-5.45%) than men (average APC = 1.56%; 95% CI, 0.73%-2.42%).
Deaths from alcohol-associated cirrhosis also surged during the study period — from 4.09 deaths per 100,000 to 9.52 deaths per 100,000 (average APC = 4%; 95% CI, 3.63%-4.4%). The researchers called the trends in cirrhosis mortality “particularly concerning” among women, who had annual increases of 8.32% (95% CI, 7.4%-9.82%) from 2011 to 2022, as well as among adults aged 25 to 44 years, who had increases of 19.51% (95% CI, 15%-28.53%) per year from 2018 to 2022.
“Alcohol-associated liver disease mortality continues to rise and has demonstrated the steepest increase in the most recent study period from 2018 to 2022,” Wong told Healio. “This is driven predominantly by alcohol-related cirrhosis, but we also observed rises in alcohol-related hepatitis mortality.”
Wong noted these findings support previous U.S. studies that demonstrate concerning trends in excessive alcohol intake and subsequent alcohol-associated liver disease.
“Our study specifically focused on mortality trends related to alcohol-associated liver disease and highlights the persistence of these trends through 2022, which likely were exacerbated by the observed surges in excessive alcohol use during the early days of the pandemic.”
Robert J. Wong, MD, MS, FACG, FAASLD, can be reached at rwong123@stanford.edu.
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Disclosures:
Wong reports receiving grants from Durect Corp., Exact Sciences, Gilead Sciences and Theratechnologies outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.
