Deaths from alcohol-related liver disease have risen sharply in the United States, with people lacking a college degree experiencing the greatest impact, according to research from Saint Louis University School of Medicine. The study, published in Alcohol: Clinical & Experimental Research, found that while death rates increased for nearly all demographic groups—including those with higher education—the gap between less affluent and more affluent populations is widening.
Researchers analyzed mortality data among Americans aged 25 and older to examine whether these trends align with the "deaths of despair" theory. This theory links rising mortality among working-age adults without a college degree to worsening social and economic conditions as well as health challenges.
"Alcohol-related liver disease is claiming lives at an accelerating pace, and the burden falls hardest on those with fewer resources," said Richard Grucza, Ph.D., professor of family and community medicine at SLU and lead author of the study. "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."
The study reported a 63% increase in deaths from alcohol-related liver disease between 2001 and 2020. The rate rose from nine to 17 deaths per 100,000 people during this period. While all groups saw increases, disparities were most pronounced among middle-aged men aged 55–74 without a college degree; this group now faces death rates as high as 50 per 100,000.
Researchers suggest that these differences are likely due to multiple factors such as obesity, diabetes, smoking, binge drinking habits, combined with ongoing social and economic stressors.
The authors emphasize the importance of targeted interventions addressing medical, behavioral, and social risks for vulnerable populations.
Other contributors to the study include Joel Jihwan Hwang; Jeffrey Scherrer, Ph.D.; Jennifer K. Bello-Kottenstette, M.D.; Sarah C. Gebauer, M.D.; Ruizhi Huang; Joanne Salas; Jinmyoung Cho—all affiliated with Saint Louis University School of Medicine or its AHEAD Research Institute—and Kevin Young Xu from Washington University School of Medicine in St. Louis.
