Trends in Premature Deaths From Alcoholic Liver Disease in the U.S., 1999-2018

Abstract

Introduction: So-called deaths of despair-those involving drug overdoses, alcohol-related liver disease, and suicide-have been rising in the U.S. among middle-aged white, non-Hispanic adults without a college degree. Premature deaths (ages 25-69) from alcoholic liver disease were examined specifically in this study from 1999 to 2018, by sex, race/Hispanic origin, and age group.

Methods: Data were drawn from the 1999-2018 Multiple Cause of Death database and bridged-race estimates of the U.S. resident population, including 281,243 alcoholic liver disease deaths or an average of 8 deaths per 100,000 population. Analyses examined alcoholic liver disease death rates for sex differences among 3 age groups (25-49, 50-59, and 60-69 years), by race and Hispanic origin, from 1999 to 2018; age-adjusted and age-specific annual percentage changes (accounted for cohorts); years of potential life lost; and age of death for sociodemographic backgrounds, alcoholic liver disease clinical courses, and comortalities.

Results: White non-Hispanics increasingly experienced greater alcoholic liver disease mortality than black non-Hispanics and Hispanics, confirming the racial and ethnic crossover observed in previous studies. Although men consistently had higher rates of mortality, male-to-female ratios decreased in the past 2 decades and were the lowest among ages 25-49 years and especially among ages 25-34 years. Although women generally had longer life expectancies, women died of alcoholic liver disease on average about 2-3 years earlier than men.

Conclusions: Prevention and intervention efforts are imperative to address the narrowing sex gap and widening racial disparities in alcoholic liver disease premature deaths.

Figure 1.

Sex-specific death rate (per 100,000 population) and male-to-female rate ratio for alcoholic liver disease, by age group and race/Hispanic origin, in the U.S., 1999–2018. Note: Gray areas indicate 95% CIs.

Figure 2.

Age-adjusted (net drift) and age-specific annual percentage changes (APC) for alcoholic liver disease mortality, by sex and race/Hispanic origin, in the U.S., 1999–2018. Note: Dashed lines and gray areas indicate 95% CIs for age-adjusted and age-specific APC, respectively (*p<0.05; ***p<0.001).