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. 2025 Feb;49(2):368-378.
doi: 10.1111/acer.15516. Epub 2024 Dec 19.

Increased mortality from alcohol use disorder, alcohol-associated liver disease, and liver cancer from alcohol among older adults in the United States: 2000 to 2021

Pojsakorn Danpanichkul  1 , Kwanjit Duangsonk  2 , Ethan Kai Jun Tham  3 , Primrose Tothanarungroj  4 , Thanida Auttapracha  4 , Vitchapong Prasitsumrit  5 , Benedix Sim  3   6 , Daniel Tung  3   6 , Romelia Barba  1 , Robert J Wong  7   8 , Lorenzo Leggio  9 , Ju Dong Yang  10 , Vincent L Chen  11 , Mazen Noureddin  12 , Luis Antonio Díaz  13   14   15 , Juan Pablo Arab  13   14   16 , Karn Wijarnpreecha  17   18   19 , Suthat Liangpunsakul  20   21   22
Affiliations

Increased mortality from alcohol use disorder, alcohol-associated liver disease, and liver cancer from alcohol among older adults in the United States: 2000 to 2021

Pojsakorn Danpanichkul et al. Alcohol Clin Exp Res (Hoboken). 2025 Feb.

Abstract

Background: To investigate the trends in alcohol-associated liver disease (ALD), liver cancer from alcohol, and alcohol use disorder (AUD) burden among older adults in the United States (US).

Methods: We gathered the ALD, liver cancer from alcohol, and AUD prevalence, mortality, and age-standardized rates (ASRs) from the Global Burden of Disease (GBD) Study 2021 between 2010 and 2021. We estimated the annual percent change (APC) with confidence intervals (CIs) for the burden of ALD, liver cancer from alcohol, and AUD in older adults (>70 years) in the United States. The findings were contrasted with global estimates and categorized by sex and state.

Results: In 2021, there were approximately 512,340 cases of AUD, 56,990 cases of ALD, and 4490 cases of primary liver cancer from alcohol among older adults in the United States. In contrast to declining ASRs of prevalence and mortality in the global burden, these parameters were increased in older adults in the United States. From 2000 to 2021, prevalence from AUD (APC: 0.54%, 95% CI 0.43% to 0.65%), ALD (APC + 0.54%, 95% CI 0.22% to 0.86%), and primary liver cancer from alcohol (APC 2.93%, 95% CI 2.76% to 3.11%) increased. Forty states in the United States exhibited a rise in the prevalence rates of ALD in older adults.

Conclusion: Our findings highlighted the increased prevalence and mortality of AUD, ALD, and primary liver cancer from alcohol among older adults in the United Sates, contrasting with the decline in global trends. Public health strategies on ALD, AUD, and primary liver cancer from alcohol, which targets older adults, are urgently needed.

Keywords: chronic liver disease; geriatric; public health; steatotic liver disease.

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Conflict of interest statement

Suthat Liangpunsakul has served as a consultant for Durect and Surrozen. Mazen Noureddin has been on the advisory board for 89BIO, Gilead, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Terns, Siemens, and Roche diagnostics; has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking and Zydus; and is a minor shareholder or has stocks in Anaetos, Rivus Pharma, and Viking. Vincent Chen's institution has received research grants from KOWA and AstraZeneca. Robert J Wong has research grants (to his institution) from Gilead Sciences, Exact Sciences, Durect Corporation, and Theratechnologies. He also consulted (without compensation) for Gilead Sciences, Salix, and Mallinckrodt.

Figures

FIGURE 1
FIGURE 1
(A) Prevalence of patients aged over 70 with alcohol use disorder (AUD) in 2000 and 2021 in the United States, by sex. (B) Prevalence of patients aged over 70 with alcohol‐associated liver disease (ALD) in 2000 and 2021 in the United States, by sex. (C) Prevalence of patients aged over 70 with primary liver cancer from alcohol in 2000 and 2021 in the United States, by sex. (D) Age‐standardized prevalence rates (ASPRs) in patients aged over 70 with AUD from 2000 to 2021 in the United States and Global. (E) ASPRs in patients aged over 70 with ALD from 2000 to 2021 in the United States and Global. (F) ASPRs in patients aged over 70 with primary liver cancer from alcohol from 2000 to 2021 in the United States and Global ASPR, age‐standardized prevalence rate.
FIGURE 2
FIGURE 2
(A) Death from patients aged over 70 with alcohol use disorder (AUD) in 2000 and 2021 in the United States, by sex. (B) Death from patients aged over 70 with alcohol‐associated liver disease (ALD) in 2000 and 2021 in the United States, by sex. (C) Death from patients aged over 70 with primary liver cancer from alcohol in 2000 and 2021 in the United States, by sex. (D) Age‐standardized death rates (ASDRs) in patients aged over 70 with AUD from 2000 to 2021 in the United States and Global. (E) ASDRs in patients aged over 70 with ALD from 2000 to 2021 in the United States and Global. (F) ASDRs in patients aged over 70 with primary liver cancer from alcohol from 2000 to 2021 in the United States and Global ASPR, age‐standardized prevalence rate.
FIGURE 3
FIGURE 3
(A) Age‐standardized prevalence rates (ASPRs) in patients aged over 70 with alcohol use disorder per 10,000 in the United States in 2021, stratified by states. (B) ASPRs in patients aged over 70 with alcohol‐associated liver disease per 10,000 in the United States in 2021, stratified by states. (C) ASPRs in patients aged over 70 with primary liver cancer from alcohol per 10,000 in the United States in 2021, stratified by states.
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