‘Alarming’ rise in alcohol-associated hepatitis reported in female teenagers, young adults
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Key takeaways:
- Rates of alcohol-associated hepatitis increased from 2002 to 2021 among adolescents and young adults in Ontario, especially among females.
- Researchers recommend targeted interventions for those most at risk.
From 2002 to 2021, the incidence rate of alcohol-associated hepatitis “more than doubled” among adolescents and young adults in Ontario, Canada, with the highest uptick observed among females, according to research in JAMA Network Open.
“Liver-related harms from alcohol are increasing at alarming rates among adolescents and young adults, especially among females, and targeted interventions are needed immediately to try and prevent these trends from continuing in the future,” Jennifer A. Flemming, MD, FRCPC, MAS, associate professor of medicine and public health sciences at Queen’s University and Kingston Health Sciences Center in Ontario, told Healio.
To investigate trends in acute alcohol-associated hepatitis (AH) among adolescents and young adults as well as differences in long-term outcomes between sexes, Flemming and colleagues conducted a population-based, retrospective study from January 2002 to December 2022. They used inpatient hospital admissions and ED records to identify 3,340 Ontario residents aged 13 to 39 years (median age, 33 years; 36% females) with an incident diagnosis of AH and no history of cirrhosis and/or decompensation. The median follow-up was 5 years.
Using the Registered Persons database, the researchers gathered data on patient sex and all-cause mortality with death date. They then used Poisson regression to compare overall and sex-specific yearly AH rates and assessed correlations between female sex and incident cirrhosis and/or decompensation as well as sex-specific liver-related mortality.
According to Flemming, the incidence rate of AH among adolescent and young adults “more than doubled” from 2002 to 2021, from 2.43 per 100,000 person-years to 6.82 per 100,000 person-years. This corresponded with an 8% yearly increase (RR = 1.08; 95% CI, 1.07-1.09). In addition, the rates were highest among females (RR = 1.11; 95% CI, 1.09-1.12) compared with males (RR = 1.07; 95% CI, 1.06-1.07).
Results also showed that 6 months following diagnosis of AH, 71% of patients were alive but at risk for complications. At a median follow-up of 4 years, 22% of those patients developed incident cirrhosis and/or decompensation (37% females vs. 29% males; P < .001).
“We also noted that among females who survived an episode of AH, they were 50% more likely to go on and develop alcohol-associated cirrhosis than were males,” Flemming said.
According to the researchers, females had a higher cumulative incidence of liver-related mortality at 10 years compared with males (11%; 95% CI, 8.3-14.2 vs. 6.9%; 95% CI, 5.4-8.6).
“These results have implications for primary, secondary and tertiary prevention of alcohol-associated liver disease,” Flemming told Healio. “From a primary prevention lens, education of governmental strategies that limit access to alcohol to the population should be addressed. From a secondary prevention lens, screening youth and young adults for harmful alcohol use and alcohol-associated liver disease (ALD) could identify at risk individuals where interventions could prevent the progression of ALD.”
She continued, “From a tertiary prevention focus, studies which evaluate outcomes of treatment for ALD specifically targeted to females with severe ALD would be an obvious next step.”
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