A disturbing new wave of research is sounding the alarm: alcohol-related liver disease (ALD) deaths are rising rapidly in the United States, and young adults are being hit especially hard. New data published June 11 in JAMA Network Open shows that between 2018 and 2022, the annual rate of ALD deaths grew nearly three times faster than in the previous decade. Experts say the consequences of increased drinking, especially during the pandemic, are only starting to appear—and the outlook is grim.
Young Adults Facing a Growing Liver Crisis
Among the most shocking findings in the study was the dramatic increase in alcohol-associated hepatitis deaths among people between the ages of 25 and 44. This condition, which can develop quickly, leads to symptoms like fatigue, liver pain, and jaundice—even in people who haven’t been drinking for many years.
“Younger adults are showing up at hospitals with severe liver damage,” said Dr. Robert Wong, a liver disease specialist at Stanford University. “Alcohol-related cirrhosis takes time to develop. So we may not see the true extent of the consequences until five, probably 10, years from now, which is very concerning.”
The study, which analyzed more than 436,000 ALD-related deaths across the country between 1999 and 2022, revealed that the death rate from alcohol-associated liver conditions nearly doubled over that time. For young adults aged 25 to 44, the annual percentage increase in deaths was about 4.2%—one of the steepest jumps among all age groups.
The Pandemic’s Lingering Impact
Researchers believe that much of this increase can be traced to the early years of the COVID-19 pandemic. Social isolation, financial stress, and mental health struggles created a perfect storm for rising alcohol use, particularly among younger adults.
“The pandemic itself came under control, but the disparities that came with it continued and lingered,” said Dr. Nasim Maleki, a psychiatry professor at Harvard Medical School who reviewed the findings.
Drinking habits changed dramatically during lockdowns. Many people reported using alcohol to cope with anxiety and uncertainty. Even now, years later, the effects are still being felt. “The consequences of heavy drinking during the pandemic are just beginning to show up in liver clinics,” said Dr. Brian Lee, a hepatologist at Keck Medicine of USC. “It puts numbers to what we’re seeing in the hospital, in the clinic.”
Death Rates Rising Across the Board
Overall, the U.S. death rate from alcohol-related liver disease rose from 6.7 to 12.5 deaths per 100,000 people between 1999 and 2022. But starting in 2018, the pace of deaths increased sharply, climbing at nearly 9% per year.
Men still had the highest death rates—about 17 per 100,000 people in 2022. But women experienced a much faster rise in death rates. Between 2018 and 2022, ALD deaths among women grew at an annual rate of 4.3%, nearly twice that of men.
One reason for this difference is biology. “Women are biologically less able to break down alcohol than men,” Dr. Lee explained. “That means even a small amount of drinking can cause more damage to their liver over time.”
Federal health guidelines recommend that women have no more than one alcoholic drink per day, while men can have up to two. But those limits are often misunderstood. “You’d be surprised by how shocked people are when they hear that drinking more than two drinks per day, for example, is considered heavy drinking by federal definitions,” Lee said.
Indigenous Communities and Racial Disparities
American Indian and Alaska Native communities are experiencing the highest death rates from ALD of any racial or ethnic group. In 2022, cirrhosis deaths among Indigenous adults reached 33 per 100,000 people. Hepatitis deaths in those groups more than doubled from 2010 to 2022.
Black Americans, meanwhile, saw a troubling shift. Early in the study period, their ALD death rates were declining. But starting in 2019, deaths began rising again at a rate of 21% per year. White Americans experienced a steady increase in deaths, climbing from 6.6 to 13.8 deaths per 100,000 over the same period.
These disparities reflect broader issues in access to care, education, and support. The pandemic deepened existing gaps and left vulnerable groups at even greater risk.
The Role of Misclassified Deaths
Researchers believe that the real number of alcohol-related liver deaths may be even higher than reported. According to Marissa Esser, former head of the alcohol program at the Centers for Disease Control and Prevention (CDC), more than 12,000 deaths from “unspecified liver cirrhosis” were likely caused by alcohol use. However, the role of alcohol often goes unlisted on official death certificates, leading to undercounting.
The CDC’s alcohol program was shut down earlier this year by the Trump administration, raising concerns among public health experts. They say this will make it harder to track and respond to the growing crisis.
In response to the growing death toll, the American Medical Association has voiced support for public education campaigns to raise awareness of alcohol’s health risks. The organization also advocates for better warning labels on alcohol containers, especially as new studies show links between alcohol use and increased cancer risks, including breast cancer.
While there are signs that alcohol use may have dropped slightly since its peak in 2020, experts say it’s too early to tell whether that will lead to fewer deaths in the years to come.
Although alcohol-related liver disease remains the leading cause of liver transplants in the U.S., researchers are exploring treatments for related liver problems. A new clinical trial published in The BMJ found that the diabetes drug dapagliflozin helped improve fatty liver disease in many patients.
“About 23% of people taking dapagliflozin experienced a complete resolution of their fatty liver disease,” said lead researcher Huijie Zhang of Nanfang Hospital in China. Nearly half of those on the drug saw liver scarring improve, without major side effects.
While this drug does not treat alcohol-related hepatitis or cirrhosis directly, it shows growing interest and progress in liver health research.
The rapid rise in alcohol-related liver deaths among young adults is a warning sign. What was once a condition mostly associated with older people is now claiming lives in their 20s, 30s, and early 40s. Doctors and researchers say the problem is only beginning to surface, and the next decade may reveal an even greater toll.
“We’re seeing younger patients with worse disease,” Dr. Wong said. “If we don’t act now, we’ll lose a generation to something that is largely preventable.”
This crisis calls for better education, stronger support systems, and honest conversations about what heavy drinking really looks like—and what it can do.
