Demographic trends and forecasts of alcohol-associated liver disease in the United States, 2008-2030

AO_SCPLOWBSTRACTC_SCPLOWAlcohol-associated liver disease (ALD) has been steadily increasing in the United States for many years, as attested by increases in ALD deaths and liver transplant demand. Direct measurement of ALD incidence is challenging as diagnosis often occurs late (or not at all). This study employs a demographically-aware backcalculation method, based on mortality data, to reconstruct latent, age-structured ALD risk and incidence trends in the US population from 2008 to 2022 and uses this information to forecast future ALD trends through 2030. We find that ALD incidence has risen steadily since 2008, with a sharp increase during the 2020 COVID-19 pandemic, and that the average age at onset has also increased over time, with demographic factors playing a substantial role. While our forecasts suggest a continuation of the pre-2020 growth in ALD incidence for most age and sex groups, we also predict marked increases among younger men, a generational shift toward older age cohorts, and substantial rises among older females. Most concerning, between 2022 and 2030, incidence is expected to double among younger men and older females and by 2030 the number of new male ALD cases is projected to be more than twice that of females for all age groups. Our results provide a clearer understanding of evolving ALD trends, highlighting the role of demographic and birth cohort effects. We underscore the urgent need for targeted interventions, particularly among younger men, to reduce ALD-related behaviors and future burden.