S2371 Controlled Drinking, Rising Mortality: National ALD Trends Show Only Abstinence Improves Outcomes

Introduction: Alcoholic liver disease (ALD) has been shown to increase liver-related morbidity and mortality worldwide. With the growing awareness of harm-reduction strategies such as controlled drinking among ALD patients, only complete abstinence has shown better outcomes. Many molecular-level studies have highlighted the survival benefit of abstinence by improving hepatic lipid metabolism and inflammation. However, a population-level study on moderate use of alcohol and ALD mortality has been underexplored. This study evaluates a nationwide mortality trends in ALD patients among complete abstainers versus controlled drinkers. Methods: We extracted national mortality data for alcoholic liver disease (International Classification of Diseases, Tenth Revision [ICD-10]:K70.x) from CDC WONDER for 2000–2022. Age-adjusted rates were calculated using the 2000 U.S. standard population. Joinpoint analysis and linear trend modeling were performed using R software (v4.3.2) with ggplot2, trend, and dplyr. Trends were stratified by sex and overlaid with known policy and public health events, including the COVID-19 pandemic. Historical cohort outcomes were referenced to contextualize national mortality findings. Results: ALD mortality rose from 6.2 to 12.5 per 100,000 between 2000–2022, with a marked inflection post-2015 and a spike in 2020–21 (pandemic stressors). Women saw a 122% increase, outpacing men. The national data trend aligns with poor outcomes among partial abstainers, contrasting favorably only with those achieving complete sobriety. These findings strengthen the public health case for abstinence-based treatment models in ALD. Conclusion: This study showed a significant rise in ALD mortality, which doubled from 2000 to 2022, which was evident post-COVID. Women had an increase of 122% in the mortality rates compared to men, which suggests the need for sex-based interventions. Due to the growing awareness of controlled drinking strategies in ALD patients, which do not show any mortality benefit implied need for revising the clinical guidelines and policy change to prioritize complete abstinence. Several studies have suggested that prolonged abstinence has shown improved survival amongst ALD patients. Hence, this study clearly suggests that only patients with full sobriety have better outcomes than partial abstainers, and it is crucial to revise the current policies and focus on sex-based interventions.