A new study shows that deaths from cirrhosis, a late stage of scarring in the liver, have been on the rise in the United States.
From 1999 to 2016, the data show, cirrhosis deaths have increased in every state in the union except one, Maryland. While rates have risen across the country, young adults have been hit especially hard. Among those aged 25 to 34, the average annual increase in cirrhosis deaths has been about 10.5 percent from 2009 to 2016. Those deaths, according to researchers, are driven entirely by alcohol-related liver disease. In other words, more young people are drinking themselves to death.
“These are largely preventable deaths,” says Neehar Parikh, a hepatologist at the University of Michigan Rogel Cancer Center and the study’s co-author. “And when young people die preventable deaths, we need to take a step back and look at what we’re doing.”
The study draws on death certificate data from Vital Statistics Cooperative and population data from the CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). The analysis showed that deaths increased by 65 percent between 1999 and 2016 to 34,174. That was an unexpected result for researchers because one of the major causes of cirrhosis, hepatitis C, has been stymied thanks to antiviral medications.
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It’s still a problem, especially among Baby Boomers, but it’s treatable. Fatty liver disease is another cause of cirrhosis, and is less easily treated. Doctors can distinguish among the causes of cirrhosis with blood tests for hepatitis C, and through patient interviews; those with fatty liver disease tend to be older and overweight, while a heavy-drinking young adult is more likely to have alcohol-related liver damage.
Researchers thought taming hepatitis C would mean a decrease in overall cirrhosis deaths. Instead, deaths have been rising. The increase really began around 2009, and the authors speculate that the Great Recession—as people lost jobs and homes—may have lead to an increase in drinking, which in turn increased cases of alcohol-related cirrhosis. That’s speculative, but Parikh explains it’s one of the few possible causes that could have affected the entire country, regardless of other regional factors. (It’s not clear, either, why Maryland has escaped unscathed.) On the question of ultimate causes, more research is needed.
But the data show a disturbing trend. “It seems almost like an epidemic we’re seeing, with these increasing numbers,” says Tinsay Woreta, assistant professor of medicine at Johns Hopkins. She says the study data mirror what she’s seen among transplant patients: People in their twenties and thirties arriving with acutely alcohol-damaged livers, in numbers never before seen. (She notes, though, that the study examines mortality—people who’ve died—rather than people seeking transplants.)
She agrees that unemployment could a driver of increase, but also suggests that untreated mental illness could play a role. “It is clear that a lot of these patients have had trouble with addiction, or even depression or anxiety,” she says, “and they’re self-medicating” with alcohol. At-risk patients may not have adequate insurance coverage for mental health treatment, or they may worry about the stigma around receiving treatment. She also notes that in our intensely individualistic American society, patients may not have the social support network necessary to qualify for a transplant—and generally stay healthier.
Andrew Muir, a professor of medicine at the Duke University School of Medicine, makes a similar point about getting people into a health system that can help them. “There are a lot of things that can be done to help people with alcohol problems,” he says. But that requires recognizing a patient who has a problem. Younger people generally don’t seek out healthcare as often; they have fewer health issues, and tend to see doctors only for a specific problem. And when he presents his patients with any of the brochures produced by the National Institute on Alcohol Abuse and Alcoholism, he says, many are shocked to realize they have a problem.
Muir suggests that while researchers have focused on hepatitis C and fatty liver disease, alcohol-related cirrhosis poses a more difficult challenge—in part because it’s preventable, but requires not just new treatments, but changing behaviors. We need more public awareness about appropriate drinking, he says, and we need more and better understanding among front-line clinicians about the scope of the problem. Then come improved screening and more comprehensive treatment. “The good news is that if you help people stop drinking, their livers get better,” he says. “The key is finding them, identifying them, and helping them.”
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