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Women Increasingly at Risk for Alcohol-Related Liver Disease

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Researchers are learning that women are becoming more at risk for severe liver disease. Getty Images
  • Women are increasingly at risk for alcohol-related liver disease.
  • Though men have higher death rates, the gap between death rates of men and women is getting smaller. This is especially true of women who are 25 to 34 years of age.
  • Higher levels of endotoxins from gut bacteria are found in women compared to men after a single episode of binge drinking.

Deaths of non-Hispanic white Americans from alcohol-associated liver disease (ALD) — especially in women — have surged since the early 2000s, a new study finds.

And health experts say it’s cause for alarm.

The report, which was published in the American Journal of Preventive Medicine, found that the number of non-Hispanic white women dying from ALD grew more rapidly compared to rates for non-Hispanic Black women.

The authors say socioeconomic and sociodemographic factors, the clinical course of ALD, and co-existing conditions have all affected the death rates.

The biggest increase was among women ages 25 to 34.

It typically takes 10 or more years of drinking to develop liver disease, so premature mortality prior to 35 is unusual — and is a public health concern, the authors say.

“Previously large gaps between women and men in alcohol-related harms, including mortality, are narrowing,” Aaron M. White, PhD, senior scientific advisor to the director at the National Institute on Alcohol Abuse and Alcoholism, said in a statement.

Of the data they studied spanning 1999 through 2018, 281,243 people ages 25 to 69 died prematurely of ALD. The team looked at other factors such as demographics, type of ALD, and other conditions that may have played a role in fatality.

Though men had higher death rates, the gap between death rates of men and women is getting smaller. This is especially true of women in the 25 to 34 age bracket.

Overall, age-specific ALD death rates were lower for women than men, and lower for people in the 25 to 49 age bracket, compared to those in the 50 to 59 and 60 to 69 age brackets.

But the male-to-female rate ratios decreased during the period, particularly among those aged 25 to 49 years. The death rate ratio of men to women went down from about 3 to 1 in 1999 to 2 to 1 in 2018.

According to the analysis, the ALD death rate increased more rapidly for women.

Women are also dying from ALD about 2 to 3 years earlier than men. That could be due to quicker increase in alcohol misuse and higher occurrence of alcoholic hepatitis in women at younger ages, along with the higher prevalence of severe obesity in women.

The years of potential life lost (YPLL), a sign or of premature death, increased more rapidly in women than men, especially after the 2008 economic recession.

“Why women appear to be more susceptible to alcohol-induced liver damage than men is not clear,” White told Healthline.

Women tend to have less water in their bodies than men who weigh comparably, which causes higher concentrations of alcohol in the blood, and thus greater exposure of organs, including the liver.

Alcohol also boosts the permeability of the gut, allowing bacterial endotoxins — and even whole bacteria — to enter the body, triggering inflammation in the liver and elsewhere.

The process is thought to play a critical role in ALD development and progression, White said.

Higher levels of endotoxins from gut bacteria are found in women compared to men after a single episode of binge drinking, he added.

Alcohol consumption has been increasing in the United States over the past few decades, and the increases have been larger for women than men, White told Healthline.

Regardless of sex, White’s study found that people with less college education saw a rapid rise in death rates compared to those who attended college.

Premature deaths from overall chronic liver disease and cirrhosis are expected to rise for all racial and ethnic groups except Black men until 2030, according to a 2018 study in The Lancet.

Alcohol’s role in liver disease is still highest among Hispanics. Historically, sex disparities in drinking were more pronounced in Hispanics than in other racial or ethnic groups.

The authors suggest that heightened rates among Hispanic women may be attributed to increases in female drinking driven by acculturation.

A 2018 analysis of six different national surveys conducted between 2000 and 2016 found that the number of women 18 and up who drink each year rose about 0.6 percent each year, and the number who binge-drink increased as well. In men, there were no increases.

“Men still drink more often and more heavily than women and are more likely to experience alcohol-related diseases, injuries, and deaths,” White said.

“However, the fact that women are drinking more and that long-standing gaps in alcohol-related harms are narrowing is a reason for concern.”

Lara Ray, PhD, a professor at UCLA studying alcohol use disorder, said the intersection between race, ethnicity, and socioeconomic status is critical.

Attending to health disparities, in alcohol use outcomes and elsewhere, requires attention from policy makers, providers, and consumers.

“One of the take-home messages for me is that health disparities are alarming and deserve our attention,” Ray told Healthline.