Epidemiology of Alcohol-Associated Hepatitis: A Systematic Review of Population-Based Studies

Alcohol-associated hepatitis is an acute and severe manifestation of alcohol-related liver injury that can occur at any stage of fibrosis. Despite its high mortality, reliable epidemiologic data on alcohol-associated hepatitis remain limited. We conducted a systematic review to synthesize available population-based estimates of alcohol-associated hepatitis annual incidence and point prevalence from 2000 to 2025.

A comprehensive literature search of MEDLINE (PubMed), Scopus, and the Cochrane Library was performed. Eligible studies reporting population-based rates of alcohol-associated hepatitis were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data.

Eleven population-based studies from 7 countries were included. Reported annual incidence rates of alcohol-associated hepatitis ranged from 1.02 per 100,000 inhabitants in Iceland to 98.5 per 100,000 inhabitants in the United States, with a median incidence rate of 6.8 cases per 100,000 inhabitants (interquartile range, 4.2-19). Among the 9 studies reporting at least 2 estimates over time, 7 demonstrated an increasing incidence rate, whereas 2 reported a decrease. A prepandemic sensitivity analysis excluding studies affected by the COVID-19 pandemic showed a similar pattern, with incidence rates increasing in 5 of the 7 studies. Two studies reported a surge in incidence during the COVID-19 pandemic, whereas 1 of them extended follow-up beyond the pandemic period and observed a gradual return toward prepandemic levels. No studies reported prevalence data.

The global burden of alcohol-associated hepatitis remains poorly characterized. Existing population-based estimates are highly heterogeneous, reflecting differences in case definitions as well as probable true epidemiologic variation across countries, and collectively suggest an increasing trend over the past 25 years. These findings underscore the urgent need for prospective studies employing standardized and harmonized methodologies to more accurately define the burden of this condition.