Premature Deaths From Alcoholic Liver Disease Trend Upward Over 2 Decades

Study data have confirmed an upward trend in premature deaths resulting from alcoholic liver disease by sex and race. This is according to study results published in the American Journal of Preventative Medicine.

Between 1999 and 2018, rates of alcoholic liver disease mortality were increasingly high, particularly among non-Hispanic White men and Hispanic women. Additionally, women were less likely than men overall to die from alcoholic liver disease, and women who died from alcoholic liver disease did so an average of 2 to 3 years earlier than men. The sex gap was particularly pronounced among Black people who died of alcohol fatty liver disease or alcoholic hepatitis. These data emphasize an unmet need for interventions designed to address sex- and race-based disparities in alcoholic liver disease treatment.   

Investigators extracted information from the Multiple Cause of Death database, which contains mortality and population counts for all counties in the United States. Data from 1999 through 2018 were accessed. Death from alcoholic liver disease was determined based on death certificate coding, and decedents with alcoholic liver disease listed as a primary or contributing cause of death were included.

Covariates of interest included age group, sex, race and Hispanic origin, sociodemographic characteristics, and comorbid conditions. Mid-year population data from the United States Census Bureau were used to provide denominators for demographic-based calculations. Years of potential life lost (YPLL) were calculated for the overall cohort, as well as for strata defined by sex, age group, and race. Premature death was defined as mortality before age 70 years.

Data were extracted from 281,243 decedents. On average, alcoholic liver disease either directly or indirectly accounted for 8 deaths per 100,000 persons in the United States. Between 1999 and 2018, alcoholic liver disease death rates were consistently lower among individuals aged 25 to 49 years compared with individuals aged 50 to 59 and 60 to 69 years.

While men had higher rates of alcoholic liver disease-related death compared with women, the sex gap narrowed considerably over time. This effect was particularly pronounced among individuals aged 25 to 49 years. Rate of YPLL also increased more rapidly for women than for men between 2007 and 2018. Over time, the greatest increases in mortality rates were observed among White non-Hispanic individuals and Hispanic women.

Mean age of alcoholic liver disease death increased between 1999 and 2018, particularly among men. On average, decedents with alcoholic fatty liver disease died earlier than those with other types of alcoholic liver disease. Women died of alcoholic liver disease about 2 to 3 years earlier than men, though this difference was less pronounced among Hispanic individuals. Among Black patients who died of alcoholic fatty liver disease and alcoholic hepatitis between 2012 and 2018, women died much younger than men.

Possession of a college degree was associated with older age of alcoholic liver disease death, except among Hispanic women. Co-occurring alcohol use disorder was associated with younger age of death among White and Hispanic men. Co-occurring injury reduced the mean age of death among Hispanic men. Notably, tobacco use disorder, diabetes, and hypertension were not significantly associated with younger age at death. In fact, each were associated with slightly older mean ages of death.  

Study limitations included the use of death certificates, which investigators note are subject to underreporting, as well as potential misclassification of race and ethnicity and a lack of information on alcoholic liver disease onset, drinking history, and treatment experiences and effectiveness.

Results from this 2-decade study emphasize the burden of alcoholic liver disease-related premature death in the United States. Even with the noted limitations, data from this study provide a robust picture of alcoholic liver disease-related death in the United States.

“Prevention and intervention efforts are imperative to address the narrowing sex gap and widening racial disparities in alcoholic liver disease premature deaths,” investigators concluded.

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Reference

Yoon YH, Chen CM, Slater ME, Jung MK, White AM. Trends in premature deaths from alcoholic liver disease in the U.S., 1999-2018. Published online August 27, 2020. Am J Prev Med. doi: 10.1016/j.amepre.2020.04.024