The Changing Epidemiology of Alcohol-Associated Liver Disease: Gender, Race, and Risk Factors

Abstract

Cases of alcohol-associated liver disease (ALD) are increasing at a steady rate in the United States with more patients presenting with alcohol-associated hepatitis (AH) and alcohol-associated cirrhosis (AC). While alcohol use has increased across many demographic groups, women are suffering from a greater increase in alcohol use disorder (AUD), and are at a greater risk of ALD due to pathophysiological differences which include absorption of alcohol, first pass metabolism, and hormonal differences. Differences across race have also been found with Native Americans and Hispanics suffering from some of the largest increases in ALD rates. Younger adults are heavily impacted by rising rates of both AUD and ALD. Comorbidities such as obesity and NASH have been shown to augment the deleterious effects of AUD and ALD, resulting in more advanced liver disease. Finally, COVID-19 and policies related to the pandemic have resulted in increased AUD across many cohorts, which has itself resulted in marked increases in ALD. In conclusion, ALD rates are rising, with young people and women particularly impacted.

Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections

“…Although prior research has shown a general rise in AH (10,12,13), our study uniquely highlights variations in the current racial burden and projects the future burden of AH for each race/ethnicity up to 2028. The disproportionately rising trend among Hispanics has been largely attributed to changing alcohol consumption habits, especially with a shift toward young adults between 15-39 years old (14).…”

Global and regional burden of alcohol-associated liver disease and alcohol use disorder in the elderly

“…In terms of sex, multiple studies have pointed out the increasing burden of ALD and AUD to a greater extent in females than in males. [34] , [35] , [36] In contrast, some studies found that the burden of ALD and AUD were lower in women, possibly owing to substantially lower levels of alcohol consumption. [37] , [38] , [39] The differences could be attributed to variations in the population of the studies, with some mainly involving younger adults or overall populations, whereas this study focused on the elderly.…”

Racial and ethnic disparities in alcohol-associated liver disease in the United States: A systematic review and meta-analysis

“…Alcohol-associated liver disease (ALD) continues to increase in the United States and has become the number one cause of death from cirrhosis and the leading indication for liver transplantation. 1 2 3 Notably, ALD prevalence among patients with advanced fibrosis (stage 3 or greater) increased from 2.2% to 6.6% from 2001 to 2016. 4 Similarly, the US prevalence of alcohol use disorder (AUD), a leading cause of ALD, has also increased and in 2018 was estimated at 5% among individuals over the age of 12 years.…”