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. 2025 Apr;31(2):525-547.
doi: 10.3350/cmh.2024.0835. Epub 2025 Jan 9.

Global epidemiology of alcohol-related liver disease, liver cancer, and alcohol use disorder, 2000-2021

Pojsakorn Danpanichkul  1 , Luis Antonio Díaz  2   3   4   5 , Kanokphong Suparan  6 , Primrose Tothanarungroj  7 , Supapitch Sirimangklanurak  7 , Thanida Auttapracha  7 , Hanna L Blaney  8 , Banthoon Sukphutanan  7   9 , Yanfang Pang  6   10   11   12 , Siwanart Kongarin  7 , Francisco Idalsoaga  4 , Eduardo Fuentes-López  13 , Lorenzo Leggio  14 , Mazen Noureddin  15 , Trenton M White  16   17 , Alexandre Louvet  18 , Philippe Mathurin  18 , Rohit Loomba  2 , Patrick S Kamath  19 , Jürgen Rehm  20   21   22   23   24 , Jeffrey V Lazarus  5   16   17   25 , Karn Wijarnpreecha  26   27   28 , Juan Pablo Arab  3   4   5   29
Affiliations

Global epidemiology of alcohol-related liver disease, liver cancer, and alcohol use disorder, 2000-2021

Pojsakorn Danpanichkul et al. Clin Mol Hepatol. 2025 Apr.

Abstract

Background/aims: Alcohol represents a leading burden of disease worldwide, including alcohol use disorder (AUD) and alcohol-related liver disease (ALD). We aim to assess the global burden of AUD, ALD, and alcohol-attributable primary liver cancer between 2000-2021.

Methods: We registered the global and regional trends of AUD, ALD, and alcohol-related liver cancer using data from the Global Burden of Disease 2021 Study, the largest and most up-to-date global epidemiology database. We estimated the annual percent change (APC) and its 95% confidence interval (CI) to assess changes in age-standardized rates over time.

Results: In 2021, there were 111.12 million cases of AUD, 3.02 million cases of ALD, and 132,030 cases of alcohol-attributable primary liver cancer. Between 2000 and 2021, there was a 14.66% increase in AUD, a 38.68% increase in ALD, and a 94.12% increase in alcohol-attributable primary liver cancer prevalence. While the age-standardized prevalence rate for liver cancer from alcohol increased (APC 0.59%; 95% confidence interval [CI] 0.52 to 0.67%) over these years, it decreased for ALD (APC -0.71%; 95% CI -0.75 to -0.67%) and AUD (APC -0.90%; 95% CI -0.94 to -0.86%). There was significant variation by region, socioeconomic development level, and sex. During the last years (2019-2021), the prevalence, incidence, and death of ALD increased to a greater extent in females.

Conclusion: Given the high burden of AUD, ALD, and alcohol-attributable primary liver cancer, urgent measures are needed to prevent them at both global and national levels.

Keywords: ALD; AUD; Alcohol-associated liver disease; Alcoholic cirrhosis; Cirrhosis; Epidemiology; Liver disease.

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Conflict of interest statement

Conflicts of Interest

Mazen Noureddin has been on the advisory board for 89bio, Gilead, Intercept, Pfizer, Novo Nordisk, Blade Therapeutics, Echosens, Fractyl, Terns, Siemens, and Roche diagnostics; has received research support from Allergan, Bristol-Myers Squibb, 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. Rohit Loomba serves as a consultant to Aardvark Therapeutics, Altimmune, Arrowhead Pharmaceuticals, AstraZeneca, Cascade Pharmaceuticals, Eli Lilly, Gilead, Glympse Bio, Inipharma, Intercept, Inventiva, Ionis, Janssen Pharmaceuticals, Lipidio, Madrigal, Neurobo, Novo Nordisk, Merck, Pfizer, Sagimet Biosciences, 89bio, Takeda, Terns Pharmaceuticals and Viking Therapeutics; has stock options in Sagimet Biosciences; his institution received research grants from Arrowhead Pharmaceuticals, Astrazeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Galectin Therapeutics, Gilead, Intercept, Hanmi, Inventiva, Ionis, Janssen, Madrigal Pharmaceuticals, Merck, Novo Nordisk, Pfizer, Sonic Incytes and Terns Pharmaceuticals; and is a Co-founder of LipoNexus. Jeffrey V. Lazarus acknowledges grants to ISGlobal from AbbVie, Boehringer Ingelheim, Echosens, Gilead Sciences, Madrigal, MSD, Novo Nordisk, Pfizer, and Roche Diagnostics; received consulting fees from Echosens, Novavax, GSK, Novo Nordisk, Pfizer and Prosciento; and received payment or honoraria for lectures from AbbVie, Echosens, Gilead Sciences, Janssen, Moderna, MSD, Novo Nordisk and Pfizer, outside of the submitted work.

Figures

Figure 1.
Figure 1.
Prevalence and age-standardized prevalence rates from 2000 to 2021 of patients with alcohol use disorder (A), alcohol-related liver disease (B), and alcohol-attributable primary liver cancer (C). Death and age-standardized death rates from 2000 to 2021 of patients with alcohol use disorder (D), alcohol-related liver disease (E), and alcohol-attributable primary liver cancer (F).
Figure 2.
Figure 2.
Age-standardized prevalence (A) and death (B) rates of patients with alcohol use disorder in 2000 and 2021, by sociodemographic index. Age-standardized prevalence (C) and death (D) rates of patients with alcohol-related liver disease in 2000 and 2021, by sociodemographic index. Age-standardized prevalence (E) and death (F) rates of patients with alcohol-attributable primary liver cancer in 2000 and 2021, by sociodemographic index.
Figure 3.
Figure 3.
Age-standardized prevalence rates of patients with alcohol use disorder (A) and alcohol-related liver disease (B) in 2021, by country. (C) Annual percent change in age-standardized prevalence rates of alcohol-related liver disease from 2000 to 2021, by country.
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