U.S. sees increase in alcohol-associated liver disease mortality
Deaths from alcohol-associated liver disease increased among men and women, across all ages, and in all racial/ethnic populations in the U.S. from 2017 through 2020, leading researchers to call for a nationwide effort to reduce national alcohol consumption, improve screening, and optimize early treatment.
Mortality related to alcohol-associated liver disease (ALD) increased in most demographic groups since 2017 as well as during the COVID-19 pandemic, with women and younger adults having the highest relative mortality increase, a study found.
Researchers compared public-use mortality data from the CDC's National Center for Health Statistics and crude monthly mortality data from the National Cancer Institute's Joinpoint Regression Program to report the average monthly percent change in crude mortality from January 2017 through December 2020. They then estimated months at which any potential changepoints occurred, stratifying by sex, age, and race/ethnicity. Results were published March 18 by Clinical Gastroenterology and Hepatology.
Age-adjusted ALD-related mortality rates per 100,000 increased each year from 2017 through 2020. Rates rose from 13.1 (95% CI, 12.9 to 13.3) in 2017 to 16.9 (95% CI, 16.7 to 17.1) in 2020 among men and from 5.6 (95% CI, 5.4 to 5.7) in 2017 to 7.7 (95% CI, 7.6 to 7.9) in 2020 among women. Strong statistical evidence supported a single changepoint in February 2020 for both sexes. The monthly percent change of crude ALD-related mortality counts was 0.36 (95% CI, 0.21 to 0.51) before February 2020 and 3.18 (95% CI, 2.20 to 4.17) afterward in men while in women, the corresponding numbers were 0.46 (95% CI, 0.28 to 0.64) and 3.8 (95% CI, 2.70 to 5.07) afterward in women, for an average monthly percent change of 0.96 (96% CI, 0.73 to 1.19) and 1.18 (95% CI, 0.90 to 1.46), respectively, from January 2017 through December 2020.
Among men and women ages 25 to 34 years, respectively, the average monthly percent changes in crude mortality were 1.29 (95% CI, 0.81 to 1.78) and 0.92 (95% CI, 0.33 to 1.51) before February 2020 and 5.37 (95% CI, 3.28 to 7.50) and 5.12 (95% CI, 1.39 to 8.98) afterward. There were similar increases after February 2020 in all age and race/ethnicity subgroups except men older than age 85 years.
The researchers noted that alcohol consumption rose during the pandemic, which itself may have complicated care for patients with ALD, and that rising rates of obesity/metabolic syndrome and comorbid nonalcoholic fatty liver disease could also have contributed.
“Although the pandemic likely contributed to this trend, our analysis indicates that some increases in ALD mortality, both in rate and absolute count, were seen prior to the pandemic,” they wrote. “Policies to reduce alcohol consumption could include changes in taxation, which have been successful in reducing alcohol consumption in other countries. Screening for high-risk alcohol use could be improved. Although recommended by the United States Preventive Services Task Force, validated screening tools and referral to evidence-based treatment are underused by primary care physicians.”