Death Rates From Liver Disease Mount Across Much of US

Pam Harrison

July 18, 2018

Deaths from liver disease continue to escalate across almost all of America and in most ethnic groups, two new studies indicate.

One of the studies, which was published online July 18 in the BMJ, shows that from 1999 to 2016, the annual mortality rate from cirrhosis increased by 65%. During the same period, the annual mortality rates from liver cancer doubled.

Most concerning of all is the fact that young people aged 25 to 34 years are dying in record numbers from cirrhosis. The increase is fueled by excessive alcohol use, say the researchers.

Lead author Elliot Tapper, MD, VA Ann Arbor Healthcare System, Michigan, told Medscape Medical News: "We all meet people with alcoholic cirrhosis in their 50s and 60s. But to develop cirrhosis in your 20s and 30s requires a profound excess of alcohol and binge-drinking behavior," he commented.

"And while obviously genetics and other factors play a role in how susceptible you are to alcohol injury, what is clear here is that there is at least a subset of individuals where there is a tremendous misuse of alcohol," he emphasized.

"There are multiple ways you can end up with cirrhosis," Tapper explained. Causes include hepatocellular carcinoma, hepatic encephalopathy, gastrointestinal hemorrhage, infections, and renal failure.

Cirrhosis is the end result of most chronic liver diseases, the researchers point out.

Increase in Deaths Fueled by Alcohol

The authors of the new study emphasize that the greatest relative increase in mortality from cirrhosis was seen in US residents aged 25 to 34 years. They say the increase is "driven entirely by alcohol related liver disease."

The average annual percentage change in death from alcoholic cirrhosis from 2009 to 2016 was 10.5% in individuals aged 25 to 34 years.

"The highest burden of age adjusted mortality due to cirrhosis was seen in Native Americans (25.8/100,000), followed by white Americans (12.7/100,000)," the researchers note.

Both Native Americans and white Americans experienced rapid increases in mortality from cirrhosis after 2009. The average annual percentage change was 4.0% for Native Americans and 3.3% for white Americans compared with African Americans, the study authors point out.

Individuals of Hispanic ethnicity also had relatively high age-adjusted mortality rates from cirrhosis, the investigators note.

The greatest average annual percentage change in cirrhosis-related mortality occurred in Kentucky, New Mexico, Arkansas, Indiana, and Alabama.

Only Maryland had a statistically significant annual decrease in cirrhosis-related deaths, although the decrease was small.

Biggest Change in Men

Tapper points out that the study findings suggest that the biggest change in cirrhosis-related mortality is occurring in men.

"This implies that this is not a global process, that there is some behavior that is disproportionately affecting men and leading to these worrisome trends," he said.

The fact that some of the poorest states in the country, including Kentucky, New Mexico, and Arkansas, are experiencing high death rates from cirrhosis suggests that the recession — which hit these states particularly hard in 2008-2009 — may be among the contributors to the epidemic of alcohol-related cirrhosis, Tapper speculated.

"Being poor doesn't mean that you abuse alcohol," Tapper emphasized.

"But we have this model of so-called deaths of despair, where if you have an abrupt and severe change in your life, one of the ways that people cope with it is by turning to alcohol," he elaborated.

"So there is some evidence to suggest that a man who is newly unemployed or newly in poverty is more likely to abuse alcohol," Tapper said.

Similarly — but, again, speculatively — young men who are facing a precarious job future with no hope in sight may be using alcohol as a way of coping with despair, he suggested.

"We need to ask people what's going on before we leap to conclusions," Tapper emphasized.

"And we need to focus on proven tools that can reduce alcohol misuse and make it less available in places where it is susceptible for misuse," he added.

Liver Cancer Mortality

The rise in liver cancer deaths, which has been reported by Medscape Medical News, is explored further in a separate but related study published online July 17.

For this study, Jiaquan Xu, MD, the Centers for Disease Control and Prevention, Atlanta, Georgia, tracked trends in liver cancer mortality among Americans aged 25 years and older between 2000 and 2016.

Analyzed by sex and race, Xu found that age-adjusted death rates from liver cancer increased by 43% for men and by 40% for women during the study period.

During the same period, death from liver cancer increased by 48% for non-Hispanic whites, by 43% for non-Hispanic blacks, and by 27% for Hispanic adults.

On the other hand, death rates from liver cancer dropped by 22% in Asians and Pacific Islanders from 2000 to 2016, although both groups had the highest death rates from liver cancer overall.

"Trends in liver cancer death rates varied by age group," Xu noted.

From 2000 to 2016, mortality rates from liver cancer increased among adults older than 65 years and especially for those aged 75 years and older.

In the last year of the analysis, Xu noted that the District of Columbia had the highest death rate from liver cancer and that Vermont had the lowest.

Dr Tapper has received grants from Valeant and Gilead and personal fees from Novartis. Dr Parikh has received personal fees from Bristol-Myers Squibb, Bayer, and Eisai as well as grants from Bayer and TARGET Pharmaceuticals. Dr Xu has disclosed no relevant financial relationships.

BMJ. Published online July 18, 2018. Full text

Cancer Immunol Res. Published online July 18, 2018.

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