Rural-urban disparities in mortality from alcoholic liver disease in the United States, 1999 to 2020

Between 2010 and 2016, alcohol-related liver disease (ALD) became the leading cause of nearly 1 in 3 liver transplants in the United States, surpassing hepatitis C. This condition is associated with high morbidity and mortality across the country. We aim to study the trends and regional disparities in ALD-related mortality among adults in the United States.

Death certificates from the CDC WONDER database were examined from 1999 to 2020 for ALD-related mortality in adults ≥25 years. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, urbanization, and geographic region.

Between 1999 and 2020, 447,109 ALD-related deaths occurred among adults ≥25 years. The AAMR increased from 6.2 in 1999 to 15.7 in 2020. Men had consistently higher AAMR than women (AAMR; men: 14.1 vs women: 5.1). Non-Hispanic (NH) American Indian/Alaska Natives had the highest overall AAMR (43.7), followed by Hispanic (13.5), NH White (9.2), NH Black (7.2), and NH Asian/Pacific Islander (2.5) population. AAMR also varied substantially by region, with highest reported AAMR in West and lowest in Northeast, nonmetropolitan areas had higher ALD-related AAMR than metropolitan. States in the top 90th percentile of ALD-related AAMR were Washington, Alaska, and Oregon.

Our study suggests an increasing trend in ALD-related mortality, especially among men, NH American Indian/ Alaska natives, and nonmetropolitan regions. Targeted strategies are needed to prevent and treat ALD among patients that are at risk to curb increasing levels of ALD-related mortality.