Deaths from liver disease have increased sharply in recent years in the United States, according to a study published in the British Medical Journal. Cirrhosis-related deaths increased by 65 percent from 1999 to 2016, and deaths from liver cancer doubled, the study said. The rise in death rates was driven predominantly by alcohol-induced disease, the report said.
Over the past decade, people ages 25 to 34 had the highest increase in cirrhosis deaths — an average of 10.5 percent per year — of the demographic groups examined, researchers reported.
The study suggests that a new generation of Americans is being afflicted "by alcohol misuse and its complications,” said lead author Elliot Tapper, a liver specialist at the University of Michigan.
Tapper said people are at risk of life-threatening cirrhosis if they drink several drinks a night or have multiple nights of binge drinking — more than four or five drinks per sitting — per week. Women tend to be less tolerant of alcohol and their livers more sensitive to damage.
The liver cleans blood as it exits the gut. The more toxins, sugars and fats consumed, the harder it has to work. If the liver gets overloaded, its plumbing can get blocked up, causing scarring that can reduce liver function.
"Dying from cirrhosis, you never wish this on anybody," Tapper said.
If people with alcohol-related disease stop drinking, "there’s an excellent chance your liver will repair itself," Tapper said. "Many other organs have the ability to regenerate to some degree, but none have the same capacity as the liver," he added. He said that he routinely sees patients going "from the sickest of the sick to living well, working and enjoying their life."
The problem, Tapper said, is that "we do not yet have a highly effective treatment for alcohol addiction.”
The Distilled Spirits Council cautions that alcohol consumption is not the only cause of cirrhosis; obesity, hepatitis and some medications can also damage the liver.
The study examined death rates in several demographic groups — divided by age, race, place of residence and gender — using death certificate data and census data. The researchers found that deaths for certain groups of people decreased between 1999 to 2008 — but rose sharply starting in 2009. They speculated that the 2008 economic crisis and subsequent rise in unemployment may have been a factor. Studies have shown that losing a job is associated with increased alcohol consumption in men.
The new study found that men were twice as likely to die from cirrhosis and nearly four times as likely to die from liver cancer as women. The study also found whites, Native Americans and Hispanic Americans are experiencing increased death rates for cirrhosis, along with people living in Kentucky, Arkansas and New Mexico. The one positive report from the study is the declining rate of deaths in Asian Americans from both cirrhosis and liver cancer.
"Scar tissue is silent, developing silently, and they [the patients] don’t know. It comes as a big surprise,” said Jessica Mellinger, a clinical lecturer at the University of Michigan who was not involved in the study. Patients typically experience the symptoms “all of a sudden,” Mellinger said of patients suffering from cirrhosis.
Initial cirrhosis symptoms of yellowing skin, jaundice and a swollen abdomen are usually the first signs that something is wrong, Mellinger said. The fluid in the abdomen can make it look and feel “like you have multiple bowling balls” in your stomach, Tapper said. As the disease progresses, the symptoms worsen, including degenerative brain injury, severe bleeding, kidney failure and increasing frailty.
The BMJ report was consistent with data issued earlier in the week by the Centers for Disease Control and Prevention. In a new report, the agency’s National Center for Health Statistics said that age-adjusted death rates for liver cancer increased steadily from 2000 through 2016 for both men and women. The agency said that liver cancer had moved to the sixth-leading cause of cancer deaths in 2016, up from the ninth-leading cause in 2000.
The increase in liver cancer comes as overall cancer death rates in the United States continue to decline, according to the National Cancer Institute.
The CDC report showed that, among the 50 states and the District of Columbia, the District had the highest liver cancer death rate in the country, followed by Louisiana, Hawaii, Mississippi and New Mexico. The five states with the lowest death rates were Vermont, Maine, Montana, Utah and Nebraska.
Laurie McGinley contributed to this report.