Liver disease deaths spike among young Americans

More Americans, especially young people, are dying of conditions related to liver cirrhosis, according to a new study.

After adjusting for age and other factors, the study — published Wednesday in the BMJ — found that deaths in the United States due to cirrhosis rose 65% and deaths from liver cancer doubled from 1999 to 2016. In that period, cirrhosis-related deaths increased for every ethnic group and for both men and women.

From 2009 to 2016, the greatest increase in death rate from cirrhosis was among people 25 to 34, according to Dr. Elliot Tapper, an assistant professor at the University of Michigan and first author on the paper.

Tapper cited a rise in binge-drinking among young people to account for the increase in cirrhosis-related mortality. To reduce these preventable deaths, he said, measures should be taken such as raising the price of alcohol and diagnosing cirrhosis using existing blood tests.

He said he had been treating more and more young people for cirrhosis and decided to conduct the study to see whether the trend held true nationwide.

“We were struck by how the current concept of who develops cirrhosis didn’t quite match what we were seeing,” he said. “It was really striking to us to have people that were younger than us in our clinic dying from cirrhosis.”

Cirrhosis, scarring of the liver, occurs when toxins such as alcohol or excess calories overwhelm the liver, triggering inflammation and eventually scarring.

Potentially life-threatening complications can arise from cirrhosis, including buildup of fluid in the stomach, formation of varicose veins and spread of toxins to the brain, causing what is known as a liver coma. The disease also increases risk for liver cancer, one of the leading causes of cancer deaths.

The new study looked at publicly available data from the US Centers for Disease Control and Prevention’s Vital Statistics Cooperative from the years 1999 to 2016. Overall, researchers found the age-adjusted mortality from cirrhosis to be 12.18 per 100,000 people. From 2008 to 2016, mortality grew annually by 3.4%.

Increase in cirrhosis mortality was greatest in Kentucky, New Mexico and Arkansas, according to the study.

The researchers compared states’ changes in alcohol-related cirrhosis mortality to their changes in alcohol use disorder. Many of the states that reported increasing rates of alcohol-related cirrhosis deaths also had rising rates of alcohol use disorder, and vice versa. Because their study was observational, though, they could not confirm that the two trends were related.

In addition to its observational nature, Tapper said a potential limitation of the study came from its use of death records, which have been found to be inaccurate around 10% of the time.

Dr. Farhad Islami, the scientific director of cancer surveillance research at the American Cancer Society, said the results of the study revealed an interesting pattern between excess alcohol consumption and rates of death due to cirrhosis in young people that warrants further study.

While the rate of deaths increased the most of any demographic among young people, the number of young people dying from cirrhosis was much more modest: In 2016, cirrhosis accounted for 1.4% of deaths of those ages 25 to 34, according to the study. Islami said inaccurate mortality reporting for this age group could have inadvertently resulted in the false appearance of an upward trend.

The study was published days after a report by the CDC’s National Center for Health Statistics that found that liver cancer death rates rose 43% between 2000 and 2016.

“What you get a sense of from our study is not a contradiction of what they’re doing; in fact, it’s a confirmation of what they found,” Tapper said. The two studies together paint a clearer picture of the needs of the current cirrhosis patient, he said: “both screening for liver cancer and intensive treatment to prevent the other morbidities associated with cirrhosis.”