Projected Prevalence and Mortality Associated with Alcohol-Related Liver Disease in the USA, 2019–40: A Modelling Study
Research article
Abstract
Background
Alcohol-related liver disease is the leading indication for liver transplantation in the USA. After remaining stable for over three decades, the number of deaths due to alcohol-related liver disease has been increasing as a result of increased high-risk alcohol use. This study aimed to project trends in alcohol-related cirrhosis and deaths in the USA up to 2040 and assess the effect of potential changes in alcohol consumption on those trends.
Methods
In this modelling study, the researchers developed a multicohort state-transition (Markov) model of high-risk alcohol use patterns and alcohol-related liver disease in high-risk alcohol use populations born in 1900–2016 in the USA projected up to 2040. The study used data from the National Epidemiologic Survey on Alcohol and Related Conditions, National Institute of Alcohol Abuse and Alcoholism, US National Death Index, National Vital Statistics System, and published studies. The researchers modelled trends in alcohol related liver disease under three projected scenarios:
- the status quo scenario, in which current trends continued;
- a moderate intervention scenario, in which trends in high-risk alcohol use reduced to 2001 levels under some hypothetical moderate intervention; and
- a strong intervention, in which trends in high-risk alcohol use decreased by 3·5% per year under some hypothetical strong intervention.
The primary outcome was to project deaths associated with alcohol-related liver disease from 2019 to 2040 for each pattern of alcohol consumption under the different scenarios.
Findings
The study model closely reproduced the observed trends in deaths due to alcohol-related liver disease from 2005 to 2018.
Under the status quo scenario, age-standardised deaths due to alcohol-related liver disease are expected to increase from 8·23 (95% uncertainty interval [UI] 7·92–9·29) per 100, 000 person-years in 2019 to 15·20 (13·93–16·19) per 100, 000 person-years in 2040, and from 2019 to 2040, 1, 003, 400 (95% CI 896 800–1 036200) people are projected to die from alcohol-related liver disease, resulting in 1, 128, 400 (1 113 200–1308400) DALYs by 2040.
Under the moderate intervention scenario, age-standardised deaths due to alcohol-related liver disease would increase to 14·49 (95% UI 12·55–14·57) per 100, 000 person-years by 2040, with 968, 100 (95% UI 845600–975900) individuals projected to die between 2019 and 2040—35, 300 fewer deaths than under the status quo scenario (a 3·5% decrease).
Whereas, under the strong intervention scenario, age-standardised deaths due to alcohol-related liver disease would peak at 8·65 (95% UI 8·12–9·51) per 100, 000 person-years in 2024 and decrease to 7·60 (6·96–8·10) per 100, 000 person-years in 2040, with 704, 300 (95% CI 632 700–731 500) individuals projected to die from alcohol-related liver disease in the USA between 2019 and 2040—299, 100 fewer deaths than under the status quo scenario (a 29·8% decrease).
Interpretation
Without substantial changes in alcohol use or interventions to address high-risk alcohol use, the disease burden and deaths due to alcohol-related liver disease will worsen in the USA. Additional interventions are urgently needed to reduce mortality and morbidity associated with alcohol-related liver disease.
Quotes
Our study underscores the need to bring alcohol-related disease to the forefront of policy discussions and identify effective policies to reduce high-risk [alcohol use] in the US,” said Dr. Jagpreet Chhatwal, senior author of the study and a senior scientist at the MGH Institute for Technology Assessment and an assistant professor at Harvard Medical School.
Dr. Jagpreet Chhatwal, senior author of the study, senior scientist at the MGH Institute for Technology Assessment, assistant professor at Harvard Medical School
With substantial investment of government resources to address the opioid epidemic, deaths due to opioid overdoses could decrease substantially in the near future. We believe similar investment of funding for alcohol-related liver disease is needed to curb increasing trends in associated deaths,” said the study researchers.
Researchers of the study
Our model highlights the long-term risk, especially for younger generations whose [alcohol use] continues to outpace older generations,” said Jovan Julien, study author and PhD student at Georgia Tech.
Jovan Julien, study author, PHD student at Georgia Tech
