S2386 State-Level Alcohol Consumption and Alcohol-Associated Liver Disease Mortality: A 10-Year US Study

Introduction: Alcohol-associated liver disease (ALD) is a leading cause of liver-related mortality in the U.S. While alcohol consumption is a known risk factor, the extent to which state-level drinking patterns align with ALD mortality remains unclear. This study aimed to evaluate the relationship between per capita alcohol consumption and ALD mortality across all 50 U.S. states over a 10 year period from 2011 to 2020. Methods: We conducted a retrospective ecological analysis using data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the CDC WONDER database. For all 50 U.S. states, we extracted per capita ethanol consumption and age-adjusted mortality rates (AAMR) for alcohol-associated liver disease International Classification of Diseases, Tenth Revision (ICD-10) code K70) from 2011 to 2020. State-level averages were calculated for both metrics. We identified the top 10 states by alcohol consumption and by AAMR and assessed correlations using Pearson coefficients across all states and within the top 10 alcohol consumption states. Results: Our results revealed no strong correlation between alcohol consumption and ALD mortality (r = 0.18, R-squared = 0.032, P < 0.05). Among the top 10 alcohol consumption states, a weak but statistically significant inverse correlation was observed (r = -0.28, R-squared = 0.078, P < 0.05) indicating that higher alcohol use did not correspond with increased ALD mortality in these states. Four states (Montana, Alaska, North Dakota, and Colorado) ranked in the top 10 for both alcohol consumption and ALD mortality. In contrast, New Mexico had the highest ALD mortality (15.6 per 100,000) but did not rank in the top 10 for alcohol use. Conclusion: These findings highlight a disconnect between population-level alcohol consumption and liver disease mortality. Factors such as healthcare access and social determinants may play a larger role in state-level ALD outcomes than alcohol consumption alone. States like Montana, Alaska, North Dakota, and Colorado, where both alcohol use and mortality are elevated, may benefit from targeted interventions including early fibrosis screening (FIB-4 or Fibroscan), routine AUDIT-C assessments, and expanded access to addiction services and access to hepatology evaluation. Future studies should explore regional disparities in ALD surveillance.