SLU Research Shows Surge in Alcohol-Related Liver Disease Driving ‘Deaths of Despair’
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ST. LOUIS — Researchers at Saint Louis University School of Medicine say deaths from alcohol-related liver disease have surged in recent years, and the increase is hitting people without a college degree the hardest. While nearly every demographic group is seeing higher death rates—including those with college degrees—the gap between economically disadvantaged groups and more affluent ones is growing, according to new research published in Alcohol: Clinical & Experimental Research.
ALD is one of the leading causes of alcohol-related deaths in the United States. Experts say its growing impact can’t be explained by changes in drinking habits alone. Instead, the data reveal a troubling trend: even when drinking patterns are similar, people with fewer economic resources suffer more severe health consequences.
Researchers looked at ALD death rates among Americans aged 25 and older to explore whether these patterns fit the “deaths of despair” theory—rising mortality among working-age adults without a college degree linked to worsening social and economic conditions and related 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 psychiatry and behavioral neuroscience at Saint Louis University School of Medicine and lead author of the study. “This isn’t just about drinking—it’s about the complex interplay of social, economic, and health factors that put certain populations at greater risk.”
Key Findings
The study shows deaths from ALD jumped 63% between 2001 and 2020, rising from nine to 17 deaths per 100,000 people. While rates climbed across nearly all groups, the increases were uneven:
- White and Asian Americans experienced the steepest increases, while rates among Black Americans remained relatively stable.
- Women experienced a bigger proportional increase than men, likely due to changing drinking patterns and their higher biological vulnerability to liver damage.
- Among women without a college degree—especially non-Hispanic White women over 45—the rise was sharpest, echoing the “deaths of despair” trend tied to economic hardship.
- ALD death rates among college-educated women nearly doubled.
- Young adults (25–34) faced almost triple the risk, and rates also surged among those aged 55–64.
The gap between education levels widened dramatically. For example, middle-aged men (55–74) without a college degree now face death rates as high as 50 per 100,000. Researchers say these disparities likely reflect a mix of factors—such as obesity, diabetes, smoking, and binge drinking—combined with social and economic stress.
The findings underscore the need for targeted alcohol guidelines and interventions that address medical, behavioral, and social risks, especially for vulnerable groups.
Other study authors include Joel Jihwan Hwang, Department of Family and Community Medicine, Saint Louis University School of Medicine; Jeffrey Scherrer, Ph.D., AHEAD Research Institute, Department of Family and Community Medicine, Saint Louis University School of Medicine; Jennifer K. Bello-Kottenstette, M.D., Department of Family and Community Medicine, Saint Louis University School of Medicine; Sarah C. Gebauer, M.D., AHEAD Research Institute, Department of Family and Community Medicine, Saint Louis University School of Medicine; Ruizhi Huang; Joanne Salas, AHEAD Research Institute, Saint Louis University School of Medicine; Jinmyoung Cho, Department of Family and Community Medicine, Saint Louis University School of Medicine; Jeffrey Scherrer, Ph.D., AHEAD Research Institute, Department of Family and Community Medicine, Saint Louis University School of Medicine; and Kevin Young Xu, Department of Psychiatry, Washington University School of Medicine in St. Louis.
About Saint Louis University
Founded in 1818, Saint Louis University is one of the nation’s oldest and most prestigious Catholic research institutions. Rooted in Jesuit values and its pioneering history as the first university west of the Mississippi River, SLU offers more than 13,300 students a rigorous, transformative education that challenges and prepares them to make the world a better place. As a nationally recognized leader in research and innovation, SLU is an R1 research university, advancing groundbreaking, life-changing discoveries that promote the greater good.
About SLU School of Medicine
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious diseases.
About AHEAD Institute
The Advanced HEAlth Data (AHEAD) Research Institute at Saint Louis University is a comprehensive center for data-driven innovation and research to improve the health of individuals and populations. The institute brings together researchers from various fields and disciplines to help improve patient and population health, advance the quality of health care and decrease health care costs. The new institute will utilize and develop data resources, novel analytic methods, predictive modeling, machine learning, and integrated wearable health devices and collaborate with national research networks.