Over the past few years, there’s been a steady rise in the rate of Americans who die by suicide and drugs each year. But while much of the attention surrounding these deaths has focused on the opioid crisis, a new study out Wednesday in the BMJ highlights a different aspect of that increase: More people, especially young adults, are dying of alcohol-related diseases such as liver cancer and cirrhosis.
Researchers at the University of Michigan studied death certificate data collected by the Centers for Disease Control and Prevention. From 1999 to 2016, nearly half a million Americans had died from cirrhosis, a chronic liver disease where the organ becomes gradually and irreversibly scarred and can eventually fail completely. More than 130,000 of those killed also had hepatocellular carcinoma, the most common form of liver cancer that is usually brought on by cirrhosis.
But compared to 1999, the researchers found, the annual rate of cirrhosis deaths jumped 63 percent by 2016, while liver cancer deaths doubled. The rise was even starker when compared to other causes of deaths. The cancer death rate in general had actually dropped over the same time period, as did deaths from cardiovascular disease, infections, and respiratory disease.
For lead author Elliot Tapper, the findings seem to confirm what he and his co-author have personally seen among their own patients.
“We had a sense from our clinical lives of treating liver disease that the epidemiology – that is, the kinds of people treated for liver disease – had shifted,” Tapper told Gizmodo. “We were shocked to find that our experience, limited as it was to the few hospitals where we practiced, could be seen throughout the US, albeit with some geographical variation.”
Though Tapper looked as far as back as 1999, the annual rise in cirrhosis deaths only began in earnest around 2008. And while cirrhosis is a chronic condition that can take years, even decades, to become deadly, the largest relative rise in mortality was remarkably seen among the young. The annual death rate jumped an average 10 percent each year from 2009 to 2016 for people between the ages of 25 to 34. And of these deaths, the rise was entirely attributed to cases caused by alcohol use.
“[This] wasn’t something we had been prepared for in our training,” Tapper said.
Other groups especially more likely to die of cirrhosis included whites and Native Americans, as well as people living throughout the southern and western US. Only one state, Maryland, had its cirrhosis death rate improve over the 18-year period.
Because of the timing of increased deaths, right around the Great Recession, Tapper says it’s more than possible the flagging economy might have contributed to these deaths.
“If this trend starts in 2008, it’s pretty easy to associate that with the most traumatic national event to happen in recent time. And there is data that links new poverty or unemployment to increased alcohol-related misuse in young men,” Tapper said, though he cautions more research needs to be done to confirm any link.
There are other factors driving the increase of cirrhosis-related deaths among older Americans, Tapper added, such as an ongoing rise of obesity and diabetes, which can contribute to non-alcoholic fatty liver disease.
Meanwhile, the rise in alcohol-related cirrhosis is likely obscuring genuine breakthroughs in preventing other causes of liver disease, such as hepatitis C. Since 2014, a whole new class of drugs has allowed doctors to cure most cases of the chronic infection (provided people can afford it).
“We cured more cases of hepatitis C in 2015 than we had in all prior years combined, and we’re making huge strides toward just wiping it off the map completely. But we don’t see any improvements in the mortality,” Tapper said.
Part of the reason for this intangibility could simply be that enough time hasn’t passed to see the life-saving effects of these new treatments, Tapper said, pointing to research showing that liver transplants due to chronic hepatitis C infection have begun to drop dramatically. “[But] there have to be opposing forces that is masking the gains that we’ve had in hepatitis C treatment, and alcohol is probably one of them.”
Despite the grim findings, Tapper says there’s still time to reverse course.
“We have to understand how best to treat and manage addiction, but at the same time, we think policies that limit the availability or ability to abuse alcohol are worth exploring,” he said. “For example, why are some states particularly hard hit compared to others? So a natural experiment would be to see if differences in price or state-based alcohol taxes might play a role. That’s probably a good first step.”
Because cirrhosis can take decades to progress, he added, there should also be more efforts to screen people for liver disease before it gets to the point of no return. [The BMJ]