Age, period and cohort effects in alcohol-related liver disease mortality in the United States, 1968 to 2023.

Abstract

Aims: Over the past two decades, mortality from alcohol-related liver disease has rapidly increased in the United States. We aimed to describe age, period and cohort contributions to alcohol-related liver disease mortality to better understand the possible drivers of recent worsening trends.

Design: Sex-stratified age-period-cohort analysis using national mortality data.

Setting and cases: The United States from 1968 to 2023 (846 008 alcohol-related liver disease deaths: 246 040 for females and 599 968 for males).

Measurements: We grouped sex-specific alcohol-related liver disease deaths and population estimates into 5-year age and period groups, with a top coded 85+ age group and one 6-year period from 2018 to 2023.

Results: Alcohol-related liver disease deaths for females and males declined from approximately the years 1980 to 2000, reaching lows of 3.00 per 100 000 population for females in 2003 and 8.70 per 100 000 for males in 2006, before steadily increasing and peaking in 2021 at 7.86 per 100 000 and 17.04 per 100 000, respectively. Mortality rates remained historically elevated through 2023. Age-period-cohort models showed the highest mortality rates among females ages 50-64 and males ages 50-69. Period effects declined from 1973-1977 to 1998-2002, then steadily increased, peaking in 2018-2023. Compared with the 2008-2012 period, females had a mortality rate ratio of 1.80 [95% confidence Interval (CI) = 1.78-1.82] in 2018-2023. Model-sensitive cohort effects have increased among the youngest birth cohorts; for example, compared with the 1958-1962 cohort, males born from 1998 to 2003 had a mortality rate ratio of 2.03 (95% CI = 1.92-2.14).

Summary: Alcohol-related liver disease deaths in the United States declined from the mid-1970s until the late 1990s before reversing, with period effects accelerating during the COVID-19 pandemic and suggestive cohort effects indicating increasing mortality risk for people born since the late 1980s. Females face disproportionate risk, consistent with their heightened susceptibility to alcohol-related liver disease and the narrowing gender gap in alcohol consumption.