Background Alcohol-related liver disease is the leading indication for liver transplantation in the USA. After remaining stable for over three decades, the number of deaths due to alcohol-related liver disease has been increasing as a result of increased high-risk drinking. We aimed to project trends in alcohol-related cirrhosis and deaths in the USA up to 2040 and assess the effect of potential changes in alcohol consumption on those trends. MethodsIn this modelling study, we developed a multicohort state-transition (Markov) model of high-risk alcohol drinking patterns and alcohol-related liver disease in high-risk drinking populations born in 1900-2016 in the USA projected up to 2040. We used data from the National Epidemiologic Survey on Alcohol and Related Conditions, National Institute of Alcohol Abuse and Alcoholism, US National Death Index, National Vital Statistics System, and published studies. We modelled trends in alcohol-related liver disease under three projected scenarios: the status quo scenario, in which current trends continued; a moderate intervention scenario, in which trends in high-risk drinking reduced to 2001 levels under some hypothetical moderate intervention; and a strong intervention, in which trends in high-risk drinking decreased by 3•5% per year under some hypothetical strong intervention. The primary outcome was to project deaths associated with alcohol-related liver disease from 2019 to 2040 for each pattern of alcohol consumption under the different scenarios. Findings Our model closely reproduced the observed trends in deaths due to alcohol-related liver disease from 2005 to 2018. Under the status quo scenario, age-standardised deaths due to alcohol-related liver disease are expected to increase from 8•23 (95% uncertainty interval [UI] 7•92-9•29) per 100 000 person-years in 2019 to 15•20 (13•93-16•19) per 100 000 person-years in 2040, and from 2019 to 2040, 1 003 400 (95% CI 896 800-1 036 200) people are projected to die from alcohol-related liver disease, resulting in 1 128 400 (1 113 200-1 308 400) DALYs by 2040. Under the moderate intervention scenario, age-standardised deaths due to alcohol-related liver disease would increase to 14•49 (95% UI 12•55-14•57) per 100 000 person-years by 2040, with 968 100 (95% UI 845 600-975 900) individuals projected to die between 2019 and 2040-35 300 fewer deaths than under the status quo scenario (a 3•5% decrease). Whereas, under the strong intervention scenario, age-standardised deaths due to alcohol-related liver disease would peak at 8•65 (95% UI 8•12-9•51) per 100 000 person-years in 2024 and decrease to 7•60 (6•96-8•10) per 100 000 person-years in 2040, with 704 300 (95% CI 632 700-731 500) individuals projected to die from alcohol-related liver disease in the USA between 2019 and 2040-299 100 fewer deaths than under the status quo scenario (a 29•8% decrease).Interpretation Without substantial changes in drinking culture or interventions to address high-risk drinking, the disease burden and deaths due to alcohol-related liver disease wi...

Background and Aims Alcohol consumption increased during the COVID‐19 pandemic in 2020 in the United States. We projected the effect of increased alcohol consumption on alcohol‐associated liver disease (ALD) and mortality. Approach and Results We extended a previously validated microsimulation model that estimated the short‐ and long‐term effect of increased drinking during the COVID‐19 pandemic in individuals in the United States born between 1920 and 2012. We modeled short‐ and long‐term outcomes of current drinking patterns during COVID‐19 (status quo) using survey data of changes in alcohol consumption in a nationally representative sample between February and November 2020. We compared these outcomes with a counterfactual scenario wherein no COVID‐19 occurs and drinking patterns do not change. One‐year increase in alcohol consumption during the COVID‐19 pandemic is estimated to result in 8000 (95% uncertainty interval [UI], 7500–8600) additional ALD‐related deaths, 18,700 (95% UI, 17,600–19,900) cases of decompensated cirrhosis, and 1000 (95% UI, 1000–1100) cases of HCC, and 8.9 million disability‐adjusted life years between 2020 and 2040. Between 2020 and 2023, alcohol consumption changes due to COVID‐19 will lead to 100 (100–200) additional deaths and 2800 (2700–2900) additional decompensated cirrhosis cases. A sustained increase in alcohol consumption for more than 1 year could result in additional morbidity and mortality. Conclusions A short‐term increase in alcohol consumption during the COVID‐19 pandemic can substantially increase long‐term ALD‐related morbidity and mortality. Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high‐risk alcohol drinking in the United States.

Introduction: Alcohol-associated liver disease (ALD) is rising in the United States because of an increase in high-risk drinking, but population-level ALD cost is unknown. Our aim was to project the direct and indirect costs associated with ALD in the US population through 2040. Methods: We utilized a previously validated microsimulation model of alcohol consumption and ALD with model parameters estimated from publicly available data sources, including the National Epidemiologic Survey Alcohol and Related Conditions-III, the Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research, the Bureau of Labor Statistics, and published studies informing the impact of alcohol consumption on ALD severity in the United States resident population. The simulated scenario included current and projected ALD-associated costs. Results: From 2022-2040, the ALD is projected to cost $880 billion; $355 billion in direct healthcare- related costs and $525 billion in lost labor and economic consumption. The annual cost of ALD is projected to increase from $31 billion in 2022 to $66 billion (118% increase) in 2040. While the female population makes up 29% of these costs in 2022, by 2040 on a per annum basis, female costs would be 43% of the total annual expenditure. Discussion: Increased consumption of alcohol in the US population, especially in females, will cause a steep rise in the economic burden of alcohol-associated liver disease in the United States. These findings highlight the need for planners and policymakers to plan for the increased impact of liver disease in the United States.

ObjectivesThe burden of alcohol-related liver disease (ALD) is surging in the US. There is evidence that alcohol consumption increased during the early periods of the coronavirus disease-2019 (COVID-19) pandemic. We describe the impact of increased alcohol consumption on alcohol-related liver disease.DesignMicrosimulation modelSettingModel parameters estimated from publicly available data sources, including national surveys on drug and alcohol use and published studies informing the impact of alcohol consumption on ALD severity.ParticipantsUS residentsMethodsWe extended a previously validated microsimulation model that estimated the short- and long-term effect of increased drinking during the COVID-19 pandemic in individuals in the US born between 1950-2012. We modelled short- and long-term outcomes of current drinking patterns during COVID-19 (status quo) using survey data of changes in alcohol consumption in a nationally representative sample between February and April 2020. We compared these outcomes with a counter-factual scenario wherein no COVID-19 occurs, and drinking patterns do not change. Reported outcomes are for individuals aged 18-65.Main outcome measuresALD-related deaths inclusive of HCC mortality, the prevalence and incidence of decompensated cirrhosis and hepatocellular carcinoma, and disability-adjusted life-years (DALYs)ResultsIncreases in alcohol consumption during 2020 due to the COVID-19 pandemic are estimated to result in to 8,200 [95% UI 7,700 – 8,700] additional ALD-related deaths (1% increase compared with the counter-factual scenario), 17,100 [95% UI 16,100 – 18,200] cases of decompensated cirrhosis (2% increase) and 1,100 [95% UI 1,100 – 1,200] cases of HCC (1% increase) between 2020 and 2040. Between 2020 and 2023, alcohol consumption changes due to COVID-19 will lead to 100 [100-200] additional deaths and 2,200 [2,200-2,300] additional decompensations in patients suffering from alcohol-related liver disease.ConclusionsA short-term increase in alcohol consumption during the COVID-19 pandemic can substantially increase long-term ALD-related morbidity and mortality. Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high-risk alcohol drinking in the US.Summary Box”What is already known on this topicThe impact of an increase in alcohol consumption during coronavirus disease 2019 (COVID-19) on drinking trajectory changes and alcohol-related liver diseases is not known.Studies have reported increases in hospital admissions for alcohol-related liver disease or pancreatitis potentially related to COVID-19, increases in alcohol consumption, and exacerbation of pre-existing liver injury, though limited evidence exists for the long-term effect of increased drinking on alcohol-related liver cirrhosis and liver cancer in the USA.Added value of this studyOur study provides new data on liver disease morbidity and mortality associated with increased consumption of alcohol during the COVID-19 pandemic.Our study suggests that drinking changes associated with the COVID-19 pandemic it is expected to lead to increases in both mortality and morbidity in the long term. to 8,200 additional ALD-related deaths, 17,100 cases of decompensated cirrhosis, and 1,100 cases of HCC between 2020 and 2040 2