Trends in the Inpatient Burden of Alcohol-related Liver Disease Among Women Hospitalized in the United States

Madeline Bertha; Kerby Shedden; Jessica Mellinger


Liver International. 2022;42(7):1557-1561. 

In This Article

Abstract and Introduction


Alcohol-related liver disease (ALD) is the leading indication for liver transplantation in the United States, but disparities for women with ALD exist. We sought to characterize trends in ALD hospitalizations and mortality among women. Using the National Inpatient Sample, we evaluated ALD and non-ALD discharges from 2003 to 2017. Multivariable logistic regression was used to evaluate mortality. ALD increased more rapidly among women, with alcohol hepatitis (AH) rising the most. When stratified by age and sex, changes in alcohol-related cirrhosis (AC) and AH were greater in women in nearly all age groups. Similar increases were present when stratified by race, notably for Native American and Asian women. AH mortality increased in women in almost all age groups. While ALD remains predominantly male, discharges and mortality have disproportionately increased among women, particularly in young women and Native Americans. These findings shed light on populations in need of intensive public health interventions.


Alcohol-related liver disease (ALD) represents a spectrum of disease ranging from fatty liver to advanced cirrhosis. ALD is now the most common indication for liver transplant in the United States (US) and represents an important public health problem.[1] It is increasingly well recognized that ALD disproportionately affects women because of increased physiological vulnerability to alcohol's toxic effects as well as to disproportionate increases in rates of heavy alcohol use among women.[2–4] Despite well-documented rising rates of ALD mortality among US women,[5] fewer studies have evaluated the intersection between sex, race and age on ALD epidemiology and inpatient burden. Our goal was to specifically characterize the burden of ALD hospitalizations and mortality among women in the US as well as to define trends in ALD discharges and mortality for intersections of sex, age and race.