US mortality trends from alcohol-associated hepatitis by sex, age, race, and ethnicity, 1999–2020

Abstract

Background: Alcohol-associated hepatitis (AH) is a subtype of alcohol-associated liver disease (ALD) resulting in severe acute liver inflammation. This study aims to examine longitudinal trends in mortality from AH in the United States (US) from 1999 to 2020, stratifying the data by sex, age, and racial/ethnic groups. Methods: We performed a cross-sectional study using data from the US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) to determine annual AH-related mortality rates (MR) in adults ≥21 years between 1999 and 2020. Data were stratified by sex, race, and 10-year age groups. Considering 1999 as baseline, mortality rate ratio (MRR) was calculated to characterize the MR in a particular year compared to baseline. Joinpoint regression analysis was conducted to characterize year-wise log-linear time calendar trends in MR. Results: From 1999 through 2020, AH-related deaths doubled from 0.5 per 100,000 (95% CI 0.5 to 0.6) to 1.1 per 100,000 (95% CI 1.1 to 1.2). While mortality rates for males doubled from 0.8 per 100,000 (95% CI 0.7 to 0.8) to 1.5 per 100,000 (95% CI 1.4 to 1.6), mortality rates for females almost tripled from 0.3 per 100,000 (9%% CI 0.3 to 0.4) to 0.8 per 100,000 (95% CI 0.7 to 0.8). The steepest increase in AH-related deaths from 1999 to 2020 were among American Indians/Alaska Natives and young adults 25–34 years, and particularly young adult females. Conclusions: Over the past two decades, overall AH-related mortality in the US has doubled. The steepest increase in AH-related mortality was noted among American Indians/Alaska Natives and young adults, particularly young adult females. Education and prevention efforts should target these high-risk populations, and studies aimed at elucidating biological and sociodemographic factors resulting in the differential rise in mortality are warranted.