Alcohol-Associated Hepatitis Rapidly Increasing in the US

Joseph C. Ahn, MD

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Rates of alcohol-associated hepatitis increased by more than 73% among patients with lower socioeconomic status in just 4 years since 2015, according to new research.¹

According to new data from a team of Mayo Clinic investigators, alcohol-associated hepatitis is on a “rapid” increase in the US—particularly among women and persons who live on a lower income. Among one of the deadliest forms of liver disease, the concerningly increasing rate of cases led investigators to advocate for heightened public health and preventive measures to reduce the risk of developing alcohol-associated hepatitis in susceptible populations.

More than one-third (35%) of patients with alcohol use disorder will develop alcohol-associated liver disease including hepatitis, according to 2022 review data. More severe cases of alcohol-associated hepatitis are linked to bacterial infections, liver and/or multiorgan failure, and a high rate of short-term mortality—anywhere up to 50% of all patients by 3 months.²

“Although the prevalence of alcohol-associated hepatitis is not well known, the global incidence is probably increasing, especially among young adults (in their 20s and 30s) and women,” Bataller et al, wrote in the review. “Its incidence has increased during the COVID-19 pandemic.”

An investigative team led by Joseph C. Ahn, MD, of the division of gastroenterology and hepatology at the Mayo Clinic, sought to define the incidence of alcohol-associated hepatitis and any risk factors for the disease in a cohort analysis. Their criteria for alcohol-associated hepatitis followed standards set by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which includes a history of heavy alcohol use for >6, and <60 days of abstinence before the onset of jaundice.³

Their retrospective analysis used data from Rochester epidemiology projects that include a cohort of adult patients hospitalized with alcohol-associated hepatitis per NIAAA criteria between 2000 – 2018. The team additionally derived baseline demographics, comorbidities, access to care, liver-related complications and disease outcomes for each patient. Incidence rates per 100,000 person-years of follow-up were calculated to determine disease prevalence.

The analysis included 204 patients with alcohol-associated hepatitis—a cumulative prevalence of 6.8 cases per 100,000 person years. From 2000 – 2004 to 2015 – 2018, the incidence of alcohol-associated hepatitis increased nearly 2-fold among males (8.4 vs 14.7 per 100,000, respectively).

Among women, the incidence of disease increased 7-fold in that time period (0.8 vs 5.9 per 100,000). Investigators additionally observed that comorbid depression and anxiety increased among women with alcohol-associated hepatitis in this time period.

What’s more, the proportion of patients with alcohol-associated hepatitis who lived in the lower socioeconomic status quartiles increased significantly in the last 2 decades—62.9% between 2000 – 2004 and again 73.3% from 2015 – 2019.

“The incidence of alcohol-associated hepatitis is increasing rapidly, especially among females and individuals of lower socioeconomic status,” investigators concluded. “There are areas of unmet need in preventative measures and treatments for comorbid psychiatric disorders in patients at high risk of alcohol-associated hepatitis.”

References

1. ^{Ahn JC, Wi CI, Buryska S, et al. Disproportionate increases in alcohol-associated hepatitis incidence in women and individuals of low socioeconomic status: A population-based study using the Rochester epidemiology project database. Hepatol Commun. 2023;7(6):e0160. Published 2023 May 31. doi:10.1097/HC9.0000000000000160}
2. ^{Bataller R, Arab JP, Shah VH. Alcohol-Associated Hepatitis. N Engl J Med. 2022;387(26):2436-2448. doi:10.1056/NEJMra2207599}
3. ^{Crabb DW, Bataller R, Chalasani NP, et al. Standard Definitions and Common Data Elements for Clinical Trials in Patients With Alcoholic Hepatitis: Recommendation From the NIAAA Alcoholic Hepatitis Consortia. Gastroenterology. 2016;150(4):785-790. doi:10.1053/j.gastro.2016.02.042}