Alcoholic Liver Disease-Related Mortality in the United States: Tracing the Trend Line

Introduction: Alcoholic liver disease (ALD) remains the most common type of chronic liver disease in the United States (US) and is a leading cause of morbidity and mortality. Our study aimed to evaluate mortality trends related to ALD in the United States between 1999 and 2020 and identify subpopulations that are disproportionately affected. Methods: We conducted cross-sectional analyses of all ALD-related mortality in the US using death certificate information from the National Vital Statistics System. Age-adjusted mortality rates (AAMR) per 100,000 population were compared among age, sex, racial/ethnic, and geographic subpopulations. Trends in mortality were examined using log-linear regression models to estimate average annual percentage change (AAPC). Results: The study identified 373,302 deaths related to ALD from 1999 to 2020. The AAMR increased from 4.34 (95% confidence interval [CI], 4.26 – 4.42) in 1999 to 7.86 (95% CI, 7.77 – 7.96) in 2020 with an AAPC of +2.7% (95% CI, 2.2 – 3.3, P < 0.001). Males (AAMR: 7.52 [95% CI, 7.49 – 7.55]) had a higher AAMR than females (AAMR: 2.88 [95% CI, 2.86 – 2.90]); however, AAPC was higher in females (AAPC: +4.0% [95% CI, 3.3 – 4.7]) compared to males (AAPC: +2.1% [95% CI, 1.6 – 2.7]). AAMR was highest in adults aged 35 to 64 years (AAMR: 9.95 [95% CI, 9.92 – 9.99]). AAPC was most prominent in individuals < 35 years (AAPC: +7.4% [95% CI, 5.3 – 9.6]). American Indian/Alaska Native (AAMR: 17.33 [95% CI, 17.03 – 17.63]) populations had the highest AAMR, followed by White (AAMR: 5.36 [95% CI, 5.34 – 5.37]), Black (AAMR: 3.64 [95% CI, 3.60 – 3.68]), and Asian/Pacific Islander (AAMR: 1.30 [95% CI, 1.26 – 1.33]) populations. Non-metropolitan (AAMR: 5.47 [95% CI, 5.42 – 5.51]) regions had a higher AAMR compared to metropolitan regions (AAMR: 5.03 [95% CI, 5.01 – 5.05]). Western (AAMR: 8.20 [95% CI, 8.15 – 8.24]) regions had the highest AAMR compared to the other United States census regions. Conclusion: The results of our study reveal a rise in ALD-related deaths from 1999 to 2020, with specific subpopulations in the US being affected at a higher rate. The subgroup analyses show a higher AAMR in men, adults aged 35 to 64 years old, Hispanic populations, and non-metropolitan regions. These findings highlight the pressing necessity for greater awareness and intervention to address the growing burden of ALD mortality in the US (Figure 1).Figure 1.: Mortality Trends Related to Alcoholic Liver Disease in the United States from 1999-2020.