Spotlight on alcohol use and health outcomes

Recent research focused on all-cause and liver-related mortality due to excessive alcohol consumption and cardiovascular outcomes in patients with alcohol-related liver disease (ALD).

One study estimated that in recent years, about 1 in 8 deaths among U.S. adults ages 20 to 64 years and about 1 in 5 deaths among those ages 20 to 49 years were attributable to excessive alcohol use. Researchers used the National Vital Statistics System to obtain mean annual national and state mortality data from 2015 through 2019 and calculated the proportion of alcohol-attributable deaths for 58 causes of death, as defined in the CDC's Alcohol-Related Disease Impact application. To account for underreporting of alcohol consumption among more than 2 million respondents to the 2015 through 2019 Behavioral Risk Factor Surveillance System, the researchers adjusted mean daily alcohol consumption using national per capita alcohol sales. Results were published Nov. 1 by JAMA Network Open.

Of 694,660 mean deaths per year among adults ages 20 to 64 years during the study period, an estimated 12.9% (89,697 per year) were attributable to excessive alcohol consumption. This percentage was higher among men than women (15.0% vs. 9.4%). Among adults ages 20 to 49 years, alcohol-attributable deaths accounted for an estimated 20.3% of total deaths (44,981 per year), with generally lower percentages in states in the Southeast and generally higher percentages in the West, upper Midwest, and New England. Across states, alcohol-attributable deaths among adults ages 20 to 64 years ranged from 9.3% of total deaths in Mississippi to 21.7% in New Mexico. The proportion of alcohol-attributable deaths to total deaths among those ages 20 to 34 years ranged from 22.4% in Utah to 33.3% in New Mexico. The estimates in the study may be conservative because they were based on deaths due to alcohol-related conditions identified as the underlying cause of death only, among other limitations, the authors noted.

A second study found higher mortality among excessive drinkers from all causes, any cancer, any circulatory disease, and any liver disease. Researchers used data from the UK Biobank to assess about 500,000 participants ages 40 to 70 years at baseline assessment from 2006 to 2010. They defined excessive drinking as reported consumption of 80 g of alcohol per day for men or 50 g of alcohol per day for women. Overall, 5,136 men (2.20% of male participants) and 1,504 women (0.60%) reported excessive drinking. Results were published Nov. 1 by Alcoholism: Clinical & Experimental Research.

A total of 811 (12.2%) of the 6,640 excessive drinkers and 29,448 (5.9%) of the other participants were recorded as having died by June 2020. Sex-adjusted mortality hazard ratios for excessive drinkers compared with all other participants were 2.02 (95% CI, 1.89 to 2.17) for all causes, 1.89 (95% CI, 1.69 to 2.12) for any cancer, 1.87 (95% CI, 1.61 to 2.17) for any circulatory disease, and 9.40 (95% CI, 7.00 to 12.64) for any liver disease. Deaths attributed to diseases of the digestive system were more common among excessive drinkers (9.5% of deaths) compared with other participants (3.4%). Abnormal liver function tests and presence of liver disease among excessive drinkers were associated with causes of death not obviously involving the liver, particularly cardiovascular disease (CVD). Limitations of the study include the fact that only those who survived to age 40 years were eligible for participation in the UK Biobank, the authors noted.

A third study found that patients with biopsy-proven ALD have increased rates of CVD compared to a matched reference population, particularly just after receiving an ALD diagnosis. Researchers looked at the risk of CVD outcomes in 3,488 patients with ALD and an available liver biopsy in Sweden between 1969 and 2016 compared with 15,461 reference individuals. Results were published Nov. 1 by Clinical Gastroenterology and Hepatology.

At baseline, patients with ALD had a median age of 58 years, with 64% being men and 58% having cirrhosis on histology. The incidence rate of CVD was 35.6 per 1,000 person-years in those with ALD compared to 19.0 per 1,000 person-years in reference individuals. While ALD was associated with a twofold increased short-term risk for CVD compared to reference individuals (subdistribution hazard ratio during the first year after diagnosis, 2.29; 95% CI, 1.79 to 2.95), this risk decreased over time. Incidence rates of CVD were comparable across histological subgroups, ranging from 27.4 CVD cases per 1,000 person-years in those with normal histology to 39.2 per 1,000 person-years in those with cirrhosis. Among other limitations, the indications for liver biopsy were unknown, and patients may have been misclassified despite having available biopsy data, the authors noted.