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Alarming Increases in Deaths from Alcoholic Cirrhosis in the U.S.

In the United States between 1999 and 2019, researchers saw a greater than three-fold increase in deaths from alcoholic cirrhosis, the final and irreversible phase of alcoholic liver disease.

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Alcoholic cirrhosis is an advanced form of alcohol-related liver disease. In the United States between 2010 and 2016, alcohol-related liver disease was the primary cause of nearly 1 in 3 liver transplants, surpassing hepatitis C.

Researchers from ������ý’s conducted an original research study utilizing the U.S. Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER) to compare trends in mortality from alcoholic cirrhosis in the U.S. in 1999 with those 20 years later in 2019. They calculated mortality rates and mortality rate ratios (MRRs) per 100,000 from alcoholic cirrhosis in 10-year age groups from ages 25 to 85 and older as measures of effect and 95 percent confidence intervals to test for significance.

Results of the study, published online ahead of print in , showed that in 1999 there were 6,007 deaths from alcoholic cirrhosis among 180,408,769 Americans ages 25 to 85 and older yielding a mortality rate of 3.3 per 100,000. In 2019, there were 23,780 deaths from alcoholic cirrhosis among 224,981,167 Americans ages 25 to 85 and older, yielding a mortality rate of 10.6 per 100,000.

“It is very sobering that in the United States between 1999 and 2019, we saw a greater than three-fold increase in deaths from alcoholic cirrhosis,” said Lawrence Fiedler, M.D., co-author, a board-certified practicing gastroenterologist and an affiliate associate professor in ������ý Schmidt College of Medicine. “Damage from chronic and excessive alcohol intake results in fatty liver disease and alcoholic hepatitis. Over time, this results in scarring and cirrhosis, the final and irreversible phase of alcoholic liver disease.”

In the U.S. between 1999 and 2019 there also were statistically significant increases in mortality from alcoholic cirrhosis in each 10-year age group from 25 to 85 and older. It also is notable that the largest increase was seven-fold in the age group 24 to 35 years and that the steepest increase was among those ages 65 to 74.

“While more research in necessary, these alarming trends in mortality from alcoholic cirrhosis pose immediate clinical and public health challenges to curb the epidemics of heavy alcohol consumption as well as overweight and obesity and lack of physical activity in the U.S., all of which may be contributory,” said , M.D., Dr . PH, corresponding author, first Sir Richard Doll Professor of Medicine and senior academic adviser, ������ý Schmidt College of Medicine.   

The researchers note that primary care providers may want to counsel all their patients that individuals who consume large amounts of alcohol have the highest mortality rates from both cirrhosis and cardiovascular disease. While the data indicate that those who select one to two drinks daily have lower risks of cardiovascular disease than nondrinkers, it is also true that the difference between drinking smaller and larger amounts of alcohol means the difference between preventing and causing premature death. 

“Specifically, rates of myocardial infarction and stroke as well as hypertension, hemorrhagic stroke and breast cancer all begin to rise above one drink daily, especially in women,” said Hennekens. “In addition, the impacts of increased alcohol consumption at earlier ages as well as overweight and obesity and lack of physical activity all may contribute, alone and in combination, to the observed increases in mortality from alcoholic cirrhosis.”

Study co-authors are Orly Termeie, ������ý medical student; Lisa Martinez, M.D.; Jennifer Foster, M.D.; and Parvathi Perumareddi, D.O., all associate professors of medicine, ������ý Schmidt College of Medicine.

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