Alcohol-Associated Liver Disease Mortality Increased During, After COVID-19 Pandemic

New research is shedding light on significant increases in mortality from alcohol-associated liver disease (ALD) in the US, particularly during and following the COVID-19 pandemic onset.1

The cross-sectional study leveraged data from the US Centers for Disease Control and Prevention (CDC) Wide Ranging Online Data for Epidemiologic Research database and found especially alarming mortality trends among women, younger adults, and American Indian or Alaska Native populations.1

According to the American Association for the Study of Liver Diseases, ALD represents a spectrum of liver injury resulting from alcohol use, ranging from hepatic steatosis to more advanced forms including alcoholic hepatitis, alcohol-associated cirrhosis, and acute AH presenting as acute-on-chronic liver failure.2 Alcohol consumption increased during the COVID-19 pandemic and, per the World Health Organization, plays a causal role in more than 200 diseases, injuries, and other health conditions.3,4

“Although previous studies have documented increasing ALD mortality rates, comprehensive analyses of COVID-19 pandemic outcomes are lacking,” Robert Wong, MD, a clinical associate professor (affiliated) at VA Palo Alto Healthcare System and Stanford University School of Medicine, and colleagues wrote.1 “Better understanding these recent trends in ALD mortality will provide important information to guide public health policies and health systems in developing appropriate interventions to improve patient outcomes. In addition, elucidating disparities in ALD mortality will identify which populations need more awareness and targeted interventions.”

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, investigators retrospectively analyzed data from the CDC Wide Ranging Online Data for Epidemiologic Research mortality database for death certificates for individuals ≥ 25 years of age across all 50 states and the District of Columbia.1

ALD mortality was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for both alcohol-associated hepatitis and alcohol-associated cirrhosis. The primary outcomes were age-adjusted annual mortality rates per 100,000 population, stratified by sex, age groups, race and ethnicity, and geographic regions.1

A total of 436,814 ALD deaths were recorded, the majority of which were male (70.7%), with ALD mortality increasing from 6.71 to 12.53 deaths per 100,000 between 1999 and 2022 and significant acceleration observed from 2018 to 2022 (annual percentage change [APC], 8.94%; 95% CI, 6.27% to 14.51%; P = .001).1

Investigators noted 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, defined as those 25 to 44 years of age, demonstrated what they referred to as “concerning” trends (AAPC, 4.23%; 95% CI, 3.47% to 4.83%; P = .001).1

Further analysis revealed American Indian and Alaska Native populations experienced the greatest 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).1

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 investigators noting women showed 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 observed among women (APC from 2011 to 2022, 8.32%; 95% CI, 7.40% to 9.82%; P = .01) and adults 25 to 44 years of age (APC from 2018 to 2022, 19.51%; 95% CI, 15.00% to 28.53%; P = .001).1

Investigators outlined several potential limitations to these findings, including the reliance on death certificate data and ICD-10 codes, the lack of individual-level data on alcohol consumption, the inability to account for comorbidities that may contribute to liver-related mortality, as well as limited socioeconomic data and the need for long-term pandemic impact monitoring.1

“These findings demand comprehensive public health strategies focused on enhanced screening, improved addiction treatment access, and targeted interventions for high-risk groups,” investigators concluded.1 “ Long-term monitoring and research into intervention effectiveness are crucial for addressing this growing public health crisis.”

References

1. Pan CW, Abboud Y, Chitnis A, et al. Alcohol-Associated Liver Disease Mortality. JAMA Network Open. 2025;8(6):e2514857. doi:10.1001/jamanetworkopen.2025.14857

2. AASLD. Alcohol-Associated Liver Disease. Accessed June 11, 2025. https://www.aasld.org/practice-guidelines/alcohol-associated-liver-disease

3. World Health Organization. Alcohol. June 28, 2024. Accessed June 11, 2025. https://www.who.int/news-room/fact-sheets/detail/alcohol