Alarming Trends: Mortality from Alcoholic Cirrhosis in the United States



      Alcoholic cirrhosis is an advanced form of alcohol-related liver disease. In the United States, between 2010 and 2016, alcohol-related liver disease was the primary cause of nearly 1 in 3 liver transplants, surpassing hepatitis C.


      We utilized the US Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database to compare trends in mortality from alcoholic cirrhosis in the United States in 1999 and 2019. We defined mortality from alcoholic cirrhosis as International Classification of Diseases code K70.3 (alcoholic cirrhosis of liver). We calculated mortality rates and mortality rate ratios (MRRs) per 100,000 from alcoholic cirrhosis in 10-year age groups from 25 to 85+ as measures of effect and 95% confidence intervals to test for significance.


      In 1999, there were 6007 deaths from alcoholic cirrhosis among 180,408,769 aged 25-85+ years, yielding a mortality rate of 3.3 per 100,000. In 2019, there were 23,780 deaths from alcoholic cirrhosis among 224,981,167 aged 25-85+ years, yielding a mortality rate of 10.6 per 100,000. The overall MRR of 3.2 was statistically significant. (P < .001), and was apparent in each 10-year age group.


      These alarming trends in mortality from alcoholic cirrhosis in the United States contribute to the formulation of many hypotheses. These require testing in analytic studies designed a priori to do so. Meanwhile, clinical and public health efforts are necessary to curb the epidemics of heavy alcohol consumption and overweight and obesity in the United States that may be contributing to these alarming trends.


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        • Lee BP
        • Vittinghoff E
        • Dodge JL
        • Cullaro G
        • Terrault NA
        National trends and long-term outcomes of liver transplant for alcohol-associated liver disease in the United States.
        JAMA Intern Med. 2019; 179: 340-348
        • Cholankeril G
        • Ahmed A
        Alcoholic liver disease replaces hepatitis C virus infection as the leading indication for liver transplantation in the United States.
        Clin Gastroenterol Hepatol. 2018; 16: 1356-1358
      1. Centers for Disease Control and Prevention. CDC WONDER. Centers for Disease Control and Prevention. Accessed February 23, 2022

      2. Centers for Disease Control and Prevention. National Center for Health Statistics. Instructions for classifying multiple causes of death, 2022. Available at: Accessed February 23, 2022.

        • Hennekens CH
        • DeMets D
        Statistical association and causation: contribution of different types of evidence.
        JAMA. 2011; 305: 1134-1135
        • Hennekens CH
        • Buring JE
        Epidemiology in Medicine.
        Little, Brown, Boston, MA1987
        • Patrick ME
        • Schulenberg JE
        • Martz ME
        • Maggs JL
        • O'Malley PM
        • Johnston LD
        Extreme binge drinking among 12th grade students in the United States: prevalence and predictors.
        JAMA Pediatr. 2013; 167: 1019-1025
      3. Caldwell M, Martinez L, Foster JG, Sherling DH, Hennekens, CH Prospects for the primary prevention of myocardial infarction and stroke. J Cardiovasc Pharmacol Ther.2019;24(3):207-214.

        • Hennekens CH
        • Andreotti F
        Leading avoidable cause of premature mortality in the world: case for obesity.
        Am J Med. 2013; 126: 97-98
        • Manson JE
        • Stampfer MJ
        • Hennekens CH
        • Willett WC.
        Body weight and longevity: a reassessment.
        JAMA. 1987; 257: 353-358
        • Sherling DH
        • Perumareddi P
        • Hennekens CH
        Metabolic syndrome: clinical and policy implications of the new silent killer.
        J Cardiovasc Pharmacol Ther. 2017; 22: 365-367
        • Hennekens CH
        • Schneider WR
        • Barice EJ.
        Obesity in childhood: introduction and general considerations.
        Pediatr Res. 2007; 61: 634-635
        • Chiang DJ
        • McCullough AJ
        The impact of obesity and metabolic syndrome on alcoholic liver disease.
        Clin Liver Dis. 2014; 18: 157-163
      4. World Heart Federation. The impact of alcohol consumption on cardiovascular health: myths and measures. Available at: Accessed February 23, 2022.

        • Kehar M
        • Griffiths R
        • Flemming JA
        Increasing incidence of cirrhosis over the past 2 decades among children in Ontario.
        Canada. Am J Gastroenterol. 2022; 1117: 189-192