Alcohol-linked liver disease and cancers rising in the U.S.
Alcohol is leaving a bigger mark on American health than many realize. New research shows that drinking drives the surge in liver disease and cancer deaths across the country.
A study published in Clinical and Molecular Hepatology, co-authored by Juan Pablo Arab, M.D., director of alcohol sciences at the Institute, tracks two decades of data from 2000 to 2021. The findings are stark: cases of alcohol-associated liver disease (ALD) and cancers tied to drinking are climbing, with rising death rates and enormous economic costs.
In 2021 alone, there were more than 28,000 new cases of ALD, nearly 228,000 people living with the disease, and almost 22,000 deaths. Over 20 years, deaths rose by nearly 80%, while new and overall cases increased by more than a third.
Women are being hit especially hard. Annual death rates from ALD rose nearly three times faster for women than men. Researchers point out that women tend to develop liver damage more quickly and are less likely to receive treatment for alcohol use disorder.
Geography also plays a role. New Mexico recorded the nation’s highest liver disease death rate in 2021, at 8.16 per 100,000, nearly double the national average. More than 40 states saw increases during the study period, including Virginia, which went from 3.13 in 2000 to 3.9 in 2021.
Alcohol is also fueling cancer deaths. In 2021, it was responsible for more than 23,000 deaths nationwide, with men dying at almost three times the rate of women. Primary liver cancer made up nearly a third of those deaths, followed by colorectal and esophageal cancers. Breast cancer, along with cancers of the mouth, throat, and voice box, accounted for smaller shares.
While some alcohol-related cancers have stayed stable or even declined, deaths from liver and pharyngeal cancers continue to rise. The District of Columbia had the highest alcohol-linked cancer death rate in 2021 (6.54 per 100,000), followed by New Hampshire and Maryland. In all, 39 states saw alcohol-related cancer deaths go up, with the sharpest increases in Oklahoma, Tennessee and West Virginia. (Virginia’s rate rose from 3.98 in 2000 to 4.24 in 2021.)
Alcohol doesn’t rival smoking in terms of cancer deaths. Smoking killed more than 150,000 Americans in 2021. But alcohol now ranks fifth among risk factors. It trails obesity, diet and high blood sugar, but unlike some of those, alcohol’s upward trend shows no sign of slowing.
National alcohol consumption rose by more than a third between 2000 and 2020. At the same time, obesity rates climbed, worsening alcohol-related liver damage. Economic stressors like the Great Recession and the COVID-19 pandemic also disrupted drinking habits, with many Americans reporting heavier use during those periods.
Awareness remains a problem. A 2020 survey found that more than half of Americans didn’t know alcohol can cause cancer, a gap that slows prevention and policy efforts.
The financial toll is staggering. Alcohol-related liver disease alone is projected to cost the U.S. $880 billion between 2022 and 2040, including hospitalizations, liver transplants, lost productivity and premature deaths.
Researchers argue that proven strategies used against tobacco could help: raising excise taxes, limiting hours of sale, and launching public education campaigns that highlight alcohol’s cancer risks. States with stronger alcohol policies tend to report lower death rates, while those with weaker measures are seeing deaths climb.
Special attention is needed for women. Alcohol use among women has been rising, narrowing the gap with men and combining with biological vulnerability to drive disproportionate harm.
Conclusions
From 2000 to 2021, alcohol-related liver disease deaths in the U.S. nearly doubled, and cancer deaths tied to drinking increased across most states. Liver, colorectal and esophageal cancers account for the largest share, but the upward trend cuts across the board.
Without stronger prevention, screening and policy action, experts warn, these numbers will keep rising. The message is clear: lowering alcohol use could save lives, not just from accidents or addiction, but from liver disease and cancer as well.