An increase in liver disease deaths among young adults fed with alcohol

Dr. Elliot Tapper treated a lot of patients, but this one stood out.

"His whole body was yellow," recalls Tapper. He could barely move, he could barely breathe and he was not eating anything.

The patient was suffering from chronic liver disease. After years of drinking, her liver had stopped filtering her blood. Bilirubin, a yellowish residual substance, accumulated in her body and changed her skin color.

Disturbing to Tapper, the man was only in his mid-thirties – much younger than most patients with liver disease.

Tapper, a liver specialist and assistant professor of medicine at the University of Michigan's School of Medicine, tried to get the patient to stop drinking.

"We had long, tearful conversations," says Tapper, "but he continued to fight alcoholism." Since then, the condition of the young man has continued to deteriorate and Tapper is not optimistic about his chances of survival.

Patient stories like this one led Tapper to look for liver diseases in young people. According to a study published Wednesday BMJ by Tapper and a colleague, fatal liver disease has increased, and young people have been most affected.

The study examined the number of deaths resulting from cirrhosis, or scarring of the liver, as well as liver cancer. The data come from the Centers for Disease Control and Prevention and cover the period from 1999 to 2016.

The analysis revealed that deaths due to liver diseases have increased dramatically, and mortality among young people grew the fastest. Although these diseases can be caused by several factors, including obesity and hepatitis C, the increase in young Americans has been caused by alcohol consumption. The number of people aged 25 to 34 who die each year from alcohol-related liver disease almost tripled between 1999 and 2016, from 259 in 1999 to 767 in 2016, an annual increase average of about 10%.

"What happens to young people is dismaying, to say the least," says Tapper.

Some ethnic groups, such as Whites and Native Americans, also saw a sharp increase in liver-related deaths in all age groups, while Americans of Asian origin saw decreases.

The rise in alcohol-related deaths overlaps with the increasing rates of excessive alcohol consumption from 2002 to 2012 observed in most of the United States

The authors noted a sharp rise in the incidence of alcohol-related deaths. mortality from 2009. The reason for this increase is uncertain. but Dr. Neehar Parikh, a liver specialist at the University of Michigan's School of Medicine and co-author of Tapper, has a theory.

"This corresponds to the global financial crisis," says Parikh. "We hypothesize that there could be a loss of opportunity, and the resulting psychological burden may have pushed some of these patients to abuse alcohol."

The increase in young Americans is particularly troubling because it kills people in the prime of their lives.

"Every young patient who dies is a tragedy," says Parikh. "These are years of life lost."

The study is the most recent to confirm that liver-related diseases are becoming more prevalent. A report released Tuesday by the CDC shows that the age-adjusted liver cancer mortality rate has increased by 43 percent since 2000. And a recent study of veterans found that cases of cirrhosis almost doubled between 2001 and 2013.

But Dr. Vijay Shah, who heads the Division of Gastroenterology and Hepatology at Mayo Clinic and did not participate in this research, says that the focus on young Americans is new.

"Alcohol-related liver cirrhosis was considered a disease that would occur after 30 years of high alcohol consumption," says Shah. "But this study shows that these problems actually occur in individuals in their twenties and thirties."

"There has been a change in the type of patient we see," admits Dr. Sumeet Asrani, a liver specialist practicing in Dallas who did not contribute to the study. "This corresponds to what we see in practice. We are seeing more and more young patients with alcoholic liver disease."

Despite the recent increase, cirrhosis remains a relatively minor cause of death among young Americans, accounting for only 1.4% of total deaths in the 25-34 age group. But it is much more important for young Native Americans, accounting for 6.3% of deaths.

Tapper thinks the problem will only get worse. Some conditions that cause liver disorders, such as hepatitis C, have decreased. But other risk factors, including obesity, are on the rise. Alcohol consumption and obesity could interact to aggravate liver disease, says Tapper.

Tapper says that he thinks politics could play a role in solving the problem. For example, the strategic taxation of alcoholic beverages could discourage consumption, just as increasing taxes on cigarettes has reduced smoking. He cites the example of Scotland, which recently set minimum prices for alcohol units in order to prevent drinking bouts. It also highlights public health interventions, such as counseling, that help people stop drinking.

The good news is that liver disease is often reversible. Many patients can recover if they stop drinking early enough.

"I had patients who came to see me in a wheelchair," says Tapper. Three months later, they shovel snow and their lab tests are normal, it's always because they made the choice to stop drinking.

Paul Chisholm is an intern at the NPR Science Office