New research paints a grim picture of liver health in the United States, revealing a sharp and troubling acceleration in deaths caused by alcohol-associated liver disease (ALD). While ALD deaths have been on the rise for years, a recent study highlights that certain groups – including women, young adults, and Indigenous people – are experiencing disproportionately rapid increases.
Data covering mortality trends through 2022 show a significant surge in ALD deaths that began in the early months of the COVID-19 pandemic and has alarmingly continued in subsequent years.
A Rapid Increase in Liver Disease Mortality
Between 2018 and 2022, the annual percentage increase in alcohol-associated liver disease deaths reached nearly 9%. This is a stark contrast to the 3.5% annual increase observed in the 12 years prior (2006-2018), signaling a worrying acceleration in recent years.
While men continue to account for a higher overall number of ALD deaths (17 per 100,000 people), the rate of increase for women has dramatically outpaced that of men. Women’s ALD death rates surged from 3 to 8 deaths per 100,000 people during the study period. On average, the annual percentage change in mortality for women was 4.3% – nearly double that of men.
Experts point to biological differences in alcohol metabolism as a contributing factor. Cisgender women typically process alcohol less efficiently than cisgender men, meaning even relatively smaller amounts of alcohol can have a greater toxic impact on their bodies. This physiological difference is part of the basis for federal drinking guidelines recommending lower daily limits for women compared to men.
Troubling Trends in Younger Adults and Severe Conditions
The study also underscores a worsening trend among younger individuals, with liver doctors deeply concerned by the increasing number of younger patients presenting with severe, sudden forms of liver inflammation.
Alcohol-associated hepatitis (AH), a severe type of liver inflammation resulting from heavy drinking, is particularly concerning in this age group. Unlike liver scarring (cirrhosis) which develops over years, AH can strike suddenly. Clinicians are now seeing younger patients exhibit hallmark symptoms like tiredness, jaundice, and liver pain, sometimes even without a long history of heavy drinking.
Individuals aged 25 to 44 experienced the highest average annual percentage change in AH mortality between 1999 and 2022. The sharpest rise for this group occurred from 2007 to 2022, with AH mortality rates changing by an alarming 8.4% annually on average. AH is now the fastest-growing indication for liver transplant, and ALD overall is the leading reason for liver transplants in the U.S.
Severe liver scarring, known as cirrhosis, remains a major driver of ALD deaths. Overall cirrhosis mortality rates more than doubled between 1999 and 2022. For women, cirrhosis deaths more than tripled in the same period. Experts caution that alcohol-related cirrhosis takes years to manifest, suggesting the full extent of the consequences from increased pandemic-era drinking may not be apparent for another five to ten years.
Deepening Disparities for Indigenous Communities
The rise in ALD mortality has not affected all racial and ethnic groups equally. American Indian or Alaska Native adults have tragically borne the brunt of this crisis, showing the highest increases in both AH mortality and overall death rates from alcohol-associated cirrhosis among all groups analyzed.
Indigenous death rates from alcohol-associated hepatitis more than doubled from 2010 to 2022, reaching 3.4 deaths per 100,000 people – the highest among all groups. Cirrhosis deaths in Indigenous communities skyrocketed to 33 deaths per 100,000 people by 2022. This represents an average annual percentage change of 18% in cirrhosis deaths for this group, significantly higher than the rates seen in white, Hispanic, and Black Americans. Experts note that existing disparities in alcohol-related disease within Indigenous communities were exacerbated during the pandemic and continue to persist.
Contributing Factors and Complexities
The increase in ALD deaths is likely multifaceted. While increased alcohol consumption during the pandemic era is a significant factor, researchers also hypothesize that underlying metabolic liver disease is becoming more common due to rising rates of conditions like obesity and hypertension. When alcohol consumption is combined with these existing metabolic issues, a synergistic effect can occur, potentially accelerating liver injury and damage. Addressing underlying metabolic health through lifestyle changes or interventions is increasingly recognized as crucial for overall liver health, and research into managing conditions like obesity-driven cirrhosis shows the potential benefits of such approaches.
It is important to note that this study primarily analyzed deaths where alcohol-associated hepatitis or cirrhosis was listed as the underlying cause. This provides a conservative estimate, as it does not capture cases where alcohol-associated liver disease was a contributing cause alongside another primary cause of death, such as heart disease. The data also lacked information on individuals’ drinking history, amounts consumed, or whether they had an alcohol use disorder.
Beyond liver disease, alcohol use is linked to numerous other serious health problems, including several types of cancer. Public health efforts are increasingly focused on raising awareness about these broader risks, such as the link between alcohol and breast cancer in women, and advocating for clearer labeling on alcoholic beverages regarding serving sizes and health warnings.
The continued rise in alcohol-associated liver disease deaths, particularly among vulnerable populations, presents a significant public health challenge that requires urgent attention and targeted interventions.
