Pan Chun-Wei, Abboud Yazan, Chitnis Amit, Zhang Wei, Singal Ashwani K, Wong Robert J
Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois.
Department of Internal Medicine, Rutgers New Jersey Medical School, Newark.
JAMA Netw Open. 2025 Jun 2;8(6):e2514857. doi: 10.1001/jamanetworkopen.2025.14857.
Alcohol-associated liver disease (ALD) is a major public health concern, accounting for one-quarter of cirrhosis-related deaths and becoming the leading indication for liver transplantation in the US, with concerning increases in mortality during and following the COVID-19 pandemic onset.
To evaluate comprehensive national trends in ALD mortality in the US from 1999 to 2022, with a particular focus on disparities related to sex, race, ethnicity, and age.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional analysis used the Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research mortality database from 1999 to 2022, examining death certificates across all 50 states and the District of Columbia. The study included individuals aged 25 years and older. Data analysis was performed from September to November 2024.
ALD mortality was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (K70.xx) for both alcohol-associated hepatitis (K70.1x) and alcohol-associated cirrhosis (K70.3x).
Primary outcomes included age-adjusted annual mortality rates per 100 000 population, stratified by sex, age groups (25-44, 45-64, 65-84, and ≥85 years), race and ethnicity, and geographic regions. Joinpoint regression analysis was used to calculate average annual percentage changes (AAPCs) and to identify significant trend changes.
In this study, a total of 436 814 ALD deaths were recorded (308 923 men [70.7%]), with ALD mortality increasing from 6.71 to 12.53 deaths per 100 000 between 1999 and 2022 and significant acceleration during 2018 to 2022 (annual percentage change [APC], 8.94%; 95% CI, 6.27% to 14.51%; P = .001). Women showed more rapid increases than men (AAPC, 4.29% [95% CI, 3.09% to 5.51%] vs 2.50% [95% CI, 1.51% to 3.51%]), whereas young adults (aged 25-44 years) demonstrated concerning trends (AAPC, 4.23%; 95% CI, 3.47% to 4.83%; P = .001). American Indian and Alaska Native populations experienced the highest mortality rates, increasing from 25.21 to 46.75 deaths per 100 000 (AAPC, 4.93%; 95% CI, 3.45% to 5.96%; P = .001). Alcohol-associated hepatitis mortality increased from 0.47 to 0.76 deaths per 100 000 (AAPC, 2.08%; 95% CI, 1.27% to 3.05%; P = .001), with women showing steeper increases than men (AAPC, 3.94% [95% CI, 2.58% to 5.46%] vs 1.56% [95% CI, 0.73% to 2.42%]). Alcohol-associated cirrhosis mortality increased from 4.09 to 9.52 deaths per 100 000 (AAPC, 4.00%; 95% CI, 3.63% to 4.40%; P = .001), with particularly concerning trends among women (APC from 2011 to 2022, 8.32%; 95% CI, 7.40% to 9.82%; P = .01) and adults aged 25 to 44 years (APC from 2018 to 2022, 19.51%; 95% CI, 15.00% to 28.53%; P = .001).
In this cross-sectional study using data from the Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research database, ALD mortality increased significantly across demographic groups, with particularly concerning trends among women, younger adults, and American Indian and Alaska Native populations. These findings highlight the urgent need for targeted public health interventions and enhanced surveillance, especially given the sustained impact of COVID-19 pandemic-related changes in alcohol consumption patterns.
酒精性肝病（ALD）是一个重大的公共卫生问题，占肝硬化相关死亡人数的四分之一，在美国正成为肝移植的主要指征，且在2019冠状病毒病大流行期间及之后死亡率令人担忧地上升。
评估1999年至2022年美国ALD死亡率的全国综合趋势，特别关注与性别、种族、族裔和年龄相关的差异。
设计、背景和参与者：这项回顾性横断面分析使用了疾病控制和预防中心1999年至2022年的广泛在线流行病学研究死亡率数据库，研究了美国50个州和哥伦比亚特区的死亡证明。研究纳入了25岁及以上的个体。数据分析于2024年9月至11月进行。
使用国际疾病分类第十版（ICD-10）编码（K70.xx）确定酒精性肝炎（K70.1x）和酒精性肝硬化（K70.3x）的ALD死亡率。
主要结局包括按性别、年龄组（25-44岁、45-64岁、65-84岁和≥85岁）、种族和族裔以及地理区域分层的每10万人口年龄调整后的年死亡率。采用Joinpoint回归分析计算平均年度百分比变化（AAPC）并确定显著的趋势变化。
在本研究中，共记录了436814例ALD死亡病例（308923例男性[70.7%]），1999年至2022年间，ALD死亡率从每10万人6.71例死亡增加到12.53例死亡，在2018年至2022年期间显著加速（年度百分比变化[APC]，8.94%；95%CI，6.27%至14.51%；P = 0.001）。女性的死亡率增长速度高于男性（AAPC，4.29%[95%CI，3.09%至5.51%]对2.50%[95%CI，1.51%至3.51%]），而年轻人（25-44岁）呈现出令人担忧的趋势（AAPC，4.23%；9�%CI，3.47%至4.83%；P = 0.001）。美国印第安人和阿拉斯加原住民的死亡率最高，从每10万人25.21例死亡增加到46.75例死亡（AAPC，4.93%；95%CI，3.45%至5.96%；P = 0.001）。酒精性肝炎死亡率从每10万人0.47例死亡增加到0.76例死亡（AAPC，2.08%；95%CI，1.27%至3.05%；P = 0.001），女性的增长幅度大于男性（AAPC，3.94%[95%CI，2.58%至5.46%]对1.56%[95%CI，0.73%至2.42%]）。酒精性肝硬化死亡率从每10万人4.09例死亡增加到9.52例死亡（AAPC，4.00%；95%CI，3.63%至4.4〇%；P = 0.001），女性（2011年至2022年的APC，8.32%；95%CI，7.40%至9.82%；P = 0.01）和25至44岁成年人（2018年至2022年的APC，19.51%；95%CI，15.00%至28.53%；P = 0.001）的趋势尤为令人担忧。
在这项使用疾病控制和预防中心广泛在线流行病学研究数据库数据的横断面研究中，ALD死亡率在各人口群体中显著上升，女性、年轻人以及美国印第安人和阿拉斯加原住民的趋势尤为令人担忧。这些发现凸显了针对性公共卫生干预措施和加强监测的迫切需求，尤其是考虑到2019冠状病毒病大流行相关酒精消费模式变化的持续影响。
