HMN 2025: How Steep rise in alcohol-related liver disease is contributing to ‘deaths of despair’ phenomenon

A striking rise in deaths from alcohol-related liver disease (ALD) is disproportionately impacting people without a college degree, flagging the heightened risk facing economically disadvantaged groups. That said, almost all demographic groups, including those with a college degree, are experiencing increased ALD death rates, according to an analysis in Alcohol: Clinical & Experimental Research.

ALD is a leading contributor to alcohol-induced mortality in the US. Its growing threat is not fully explained by changes in alcohol use, and the socioeconomic disparities in alcohol-related mortality are widening. This speaks to the paradox that alcohol-related harms fall more heavily on the economically disadvantaged even when their drinking behaviors are similar to those of more affluent people.

Investigators examined trends in ALD mortality among Americans aged 25 and older to see whether they aligned with the “deaths of despair” theory—elevated death rates among working-age adults without a college degree stemming from deteriorating social and economic conditions manifesting as behavioral health problems.

From 2001 to 2020, mortality rates from ALD rose by 63%, from 9 to 17 deaths per 100,000. Increases affected all demographic categories except Black Americans. White Americans and Asian Americans experienced steep rises. Women saw a greater proportional increase than men, likely reflecting their changing alcohol use patterns and greater susceptibility to alcohol-related liver damage.

The rate of ALD deaths rose faster among women without a college degree, especially non-Hispanic white women aged 45+, aligning with deaths of despair patterns. But even among college-educated women, rates of ALD nearly doubled. Among people aged 25–34, risk almost tripled; those aged 55–64 also experienced steep rises.

Based on a comparison of risk between groups, ALD mortality disparities widened by educational achievement, especially among non-Hispanic white men aged 55–74 and women aged 45–74. This supports the deaths-of-despair theory. The probability of dying by ALD also underscored the magnitude of risk for those without higher education. Among middle-aged men aged 55–74 without degrees, death rates have reached 50 per 100,000.

These disproportionate increases among socioeconomically disadvantaged people likely reflect uneven rates of obesity and diabetes, smoking, binge drinking, and other factors. The findings point to the importance of tailoring alcohol use guidelines and interventions to high-risk groups and for addressing the full spectrum of medical, behavioral, and social factors that elevate ALD risk.

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