Alcohol-related liver disease (ALD) mortality continues to increase among the younger population in the United States (US). However, restrictive alcohol control policies may have the potential to significantly reduce ALD mortality. These findings are based on the results of a study published in Gastroenterology.

A group of investigators sought to determine the effects of alcohol policies on variations and recent trends in ALD in the US.

The CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) platform (1999-2017) was used to acquire age-adjusted ALD related mortality rates from each state in the US for adults 25 years and older. The Alcohol Policy Scale (APS) was utilized to quantify the strength of each state’s alcohol-related policies.

Continue Reading

The investigators found that APS-tax showed no association with ALD mortality. On the contrary, APS-no tax was significantly associated with ALD mortality.

Stratified by sex, APS and APS-no tax showed significant negative associations with ALD mortality (i.e., more restrictive policies associated with lower ALD mortality) in both men and women, with men having a stronger association compared with women.

When ALD was stratified by race/ethnicity, there was a significant inverse association between APS and mortality from ALD in Hispanics, Whites, and African Americans, with the strongest negative association observed in Hispanics.

In the analysis of APS as a time-varying covariate, the investigators noted a significant negative association between APS and ALD mortality in 25-44 year olds, as well as in female subgroups.

Compared to no change states, states with a 5% increase in APS had a relative decrease in ALD mortality post-change, reaching statistical significance after more than 5 years following the change.

Analysis of the APS subscales showed a decreased observed vs expected mortality in the change states. However, these changes were not considered statistically significant.

This study had several limitations. There remained the possibility of misclassification bias as well as a lack of measurement of absolute prices of alcohol. Additionally, in the difference in differences analysis, there may have been alternate significance change thresholds. Lastly, the particular policies that were associated with decreased mortality were not determined.

Despite these limitations, the study authors concluded that stricter alcohol policies were associated with lower overall ALD mortality.

Disclosure: This study was funded by multiple sources. Please refer to the original article for a full list of disclosures.


Parikh ND, Chung GS, Mellinger J, Blanchette JG, Naimi TS, Tapper EB. Alcohol policies and alcohol-related liver disease mortality. Gastroenterol. Published online March 19, 2021. doi: 10.1053/j.gastro.2021.03.031