Alcohol-related liver disease deaths surge with widening socioeconomic gaps

Researchers at Saint Louis University School of Medicine say deaths from alcohol-related liver disease have surged in recent years, and the increase is hitting people without a college degree the hardest. While nearly every demographic group is seeing higher death rates-including those with college degrees-the gap between economically disadvantaged groups and more affluent ones is growing, according to new research published in Alcohol: Clinical & Experimental Research.

Alcohol-related liver disease is one of the leading causes of death in the U.S. Experts say its growing impact can't be explained by changes in drinking habits alone. Instead, the data reveal a troubling trend: even when drinking patterns are similar, people with fewer economic resources suffer more severe health consequences.

In the study, researchers looked at alcohol-related liver disease death rates among Americans aged 25 and older to explore whether these patterns fit the "deaths of despair" theory-rising mortality among working-age adults without a college degree linked to worsening social and economic conditions and health-related challenges.

Alcohol-related liver disease is claiming lives at an accelerating pace, and the burden falls hardest on those with fewer resources. This isn't just about drinking-it's about the complex interplay of social, economic, and potentially modifiable health risk factors that put certain populations at greater risk."

Richard Grucza, Ph.D., professor of family and community medicine at SLU and lead author of the study

Key findings

The study shows deaths from alcohol-related liver disease jumped 63% between 2001 and 2020, rising from nine to 17 deaths per 100,000 people. While rates climbed across nearly all groups, the increases were uneven:

• White Americans experienced the steepest increases, while rates among Black Americans remained relatively stable.
• Women experienced a bigger proportional increase than men, likely due to changing drinking patterns and their higher biological vulnerability to liver damage.
• Among women without a college degree-especially women over 45-the rise was sharpest, echoing the "deaths of despair" trend tied to economic hardship.
• Alcohol-related liver disease death rates among college-educated women nearly doubled.
• Young adults aged 25–34 faced almost triple the risk, and rates also surged among those aged 55–64.

The gap between education levels widened dramatically. For example, middle-aged men aged 55–74 without a college degree now face death rates as high as 50 per 100,000. Researchers say these disparities likely reflect a mix of factors-such as obesity, diabetes, smoking, and binge drinking-combined with social and economic stress.

The findings underscore the need for targeted alcohol guidelines and interventions that address medical, behavioral, and social risks, especially for vulnerable groups.

Other study authors include Joel Jihwan Hwang, Department of Family and Community Medicine, Saint Louis University School of Medicine; Jeffrey Scherrer, Ph.D., AHEAD Research Institute, Department of Family and Community Medicine, Saint Louis University School of Medicine; Jennifer K. Bello-Kottenstette, M.D., Department of Family and Community Medicine, Saint Louis University School of Medicine; Sarah C. Gebauer, M.D., AHEAD Research Institute, Department of Family and Community Medicine, Saint Louis University School of Medicine; Ruizhi Huang; Joanne Salas, AHEAD Research Institute, Saint Louis University School of Medicine; Jinmyoung Cho, Department of Family and Community Medicine, Saint Louis University School of Medicine; Jeffrey Scherrer, Ph.D., AHEAD Research Institute, Department of Family and Community Medicine, Saint Louis University School of Medicine; and Kevin Young Xu, Department of Psychiatry, Washington University School of Medicine in St. Louis.