Alcohol-related cirrhosis mortality, 1990-2021: temporal trends and development-level inequalities

We analyzed global and regional trends from 1990 to 2021, examined the impact of the Human Development Index (HDI), and compared spatial clusters in 1990 and 2021.

Alcohol-related cirrhosis is a major cause of liver-related mortality, but long-term patterns remain incompletely understood.

Age-standardized mortality rates (ASMRs) for alcohol-related cirrhosis were obtained from the Global Burden of Disease 2021 study for 1990-2021. Temporal trends were evaluated using joinpoint regression. Differences by country development status (more vs. less developed using an HDI 0.700 cutoff) were assessed with multilevel longitudinal modeling. Spatial clustering was identified with Local Moran's I.

Globally, the ASMR of alcohol-related cirrhosis declined from 5.40 to 4.08 per 100,000 between 1990 and 2021, a 24% reduction, with larger relative declines observed in females than in males. The average annual percentage change (AAPC) in ASMR was -0.89%, with the steepest decline in North Africa and the Middle East and an increase in Central and Eastern Europe and Central Asia. Multilevel analysis over 1990-2021 showed faster yearly declines in ASMR in more developed countries compared with less developed ones. Spatial analysis revealed a shift of hotspots from Latin America and Africa in 1990 to Eastern Europe and Central Asia in 2021.

Global alcohol-related cirrhosis mortality has declined but remains uneven, rising in Central and Eastern Europe and Central Asia and falling faster in more developed countries. Further progress needs targeted alcohol control and stronger health systems, especially in less-developed and hotspot regions where high-burden countries cluster.