Trends in mortality of alcoholic liver disease among adults in the United States, 1999-2017

Some subtypes of alcoholic liver disease (ALD) recently had increasing prevalence or mortality. Prevalence of alcoholic fatty liver disease was increased. Mortality of alcoholic hepatitis and cirrhosis also had upward trends. However, trends in ALD- mortality and related factors are unclear. We therefore examined trends in age-standardized ALD-mortality among U.S. adults by factors using multivariable piecewise log-linear models. We collected mortality-data (age-standardized for the 2000 U.S. standard population) from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database (CDC WONDER), using the Multiple Cause of Death Data to identify all ALD deaths in the United States for 1999-2017. We identified 296,194 deaths of ALD during 1999-2017. Trends in multivariable-adjusted, age-standardized mortality did not differ by sex, race, age or urbanization. The age-standardized mortality ratios of male/female, White/non-White and Metropolitan/Non-Metropolitan were 2.346, 1.657 and 0.851 in 2017, respectively. Strikingly, our multivariable model showed that subjects of 65+ years had the highest and the fastest growing mortality in the 3 age-groups. These findings highlight the continuation of health disparities in ALD, particularly in elderly subjects. Further works are warranted to validate and delineate the associated factors.