Drinking-related liver disease and deaths on the rise in U.S.

(Reuters Health) – Americans today are expected to live shorter lives than just a few years ago, in contrast with trends seen in other developed nations, and rising deaths from alcohol-related liver disease may be partly to blame, researchers say.

Analyzing data from the Centers for Disease Control and Prevention, they found that U.S. deaths from alcohol-related liver disease (ALD) are at their highest levels since 1999 and have risen every year since 2006 in nearly every racial, ethnic and age group.

“I bet a lot of people would be surprised by the statistic that life expectancy is actually falling in the United States,” lead study author Dr. Andrew Moon of the University of North Carolina at Chapel Hill said in a phone interview.

“We think that increasing alcohol use is likely playing a role and then possibly in combination with an increase in other underlying liver diseases, putting people at increased risk for alcohol-related liver disease,” Moon told Reuters Health.

“There is data showing that alcohol use, particularly high-risk drinking, has increased in recent years.”

Alcohol-related liver disease takes several forms and could be tied to increased alcohol use over time or binge drinking.

The researchers analyzed causes of death for people aged 25 and older in the two decades since 1997, and found that 2017 had the highest rates of death from ALD, at 13.1 per 100,000 deaths in men and 5.6 per 100,000 in women. That compares to 1999 ALD mortality rates of 10.6 per 100,000 in men and 3.3 per 100,000 in women.

Mortality rates and recent increases in ALD diagnoses were particularly pronounced among middle-aged adults, Native Americans and non-Hispanic whites, the researchers report in the American Journal of Gastroenterology.

For example, compared with non-Hispanic whites, Native Americans had twice the ALD mortality in 2017. The absolute increases in mortality rates have been particularly pronounced in Native American women, the authors note. This could indicate a public health crisis in this community and studying the disease in Native Americans should be high priority, they write.

People aged 55-64 had the highest rate of deaths among all age groups, and rural areas showed higher mortality rates than urban ones.

Non-Hispanic black men were the only group that did not experience increasing rates of ALD deaths, the authors point out.

Men who consume over two drinks a day and women who consume more than one are at risk of accumulating fat in the liver, Moon said. Binge drinking, on the other hand, has been associated with alcoholic hepatitis or severe inflammation of the liver that can lead to organ failure and death, while persistent drinking over years could result in liver scarring or cirrhosis that impedes the organ from its regular functioning.

For all these conditions, “the most important treatment is abstinence from alcohol,” Moon said. “Stopping alcohol will reverse fat in the liver, reduce the risk of future alcoholic hepatitis flares and improve liver function in patients with alcohol-related cirrhosis.”

“I think, based on these data, the public need to be aware that this (ALD) is a true, up-and-coming problem,” said Dr. Suthat Liangpunsakul of the Indiana University School of Medicine in Indianapolis, who wasn’t involved in the study.

“ALD is not only a disease of the liver . . . patients often have addiction problems too and need to be treated holistically,” he said in a phone interview.

SOURCE: bit.ly/2Oalafh American Journal of Gastroenterology, online October 31, 2019.