Semin Liver Dis 2023; 43(01): 050-059
DOI: 10.1055/a-2000-6680
Review Article

The Changing Epidemiology of Alcohol-Associated Liver Disease: Gender, Race, and Risk Factors

Ahmad Anouti
1   Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Jessica L. Mellinger
2   Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
3   Department of Psychiatry, University of Michigan Health System, Ann Arbor, Michigan
› Author Affiliations
Funding The study received funding from: U.S. Department of Health and Human Services National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, K23 026333.


Cases of alcohol-associated liver disease (ALD) are increasing at a steady rate in the United States with more patients presenting with alcohol-associated hepatitis and alcohol-associated cirrhosis. While alcohol use has increased across many demographic groups, women are suffering from a greater increase in alcohol use disorder (AUD), and are at a greater risk of ALD due to pathophysiological differences which include absorption of alcohol, first pass metabolism, and hormonal differences. Differences across race have also been found with Native Americans and Hispanics suffering from some of the largest increases in ALD rates. Younger adults are heavily impacted by rising rates of both AUD and ALD. Comorbidities such as obesity and NASH have been shown to augment the deleterious effects of AUD and ALD, resulting in more advanced liver disease. Finally, COVID-19 and policies related to the pandemic have resulted in increased AUD across many cohorts, which have resulted in marked increases in ALD. In conclusion, ALD rates are rising, with young people and women particularly impacted.

Publication History

Accepted Manuscript online:
18 December 2022

Article published online:
10 February 2023

© 2023. Thieme. All rights reserved.

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