The global epidemiology of alcohol-associated liver disease

Alcohol-associated harm remains a major, largely preventable driver of global morbidity, mortality, and societal costs, and alcohol-associated liver disease (ALD) is a major consequence of long-term exposure. According to the World Health Organization, average consumption was 5.0 L of pure alcohol per person aged ≥15 years in 2022, with 21% unrecorded consumption and substantial regional variation. Per-capita intake declined from 5.7 L in 2010 to 5.0 L in 2022, yet current models forecast an increase to 5.7 L by 2030. In 2023, an estimated 3.15 million people were living with alcohol-associated cirrhosis, and 419,429 new cases occurred; while crude burden has risen, age-standardized prevalence was 34.6 per 100,000, reflecting demographic shifts. Age-standardized mortality due to ALD cirrhosis was highest in the European Region (5.8 per 100,000) and the Americas (5.0 per 100,000), and projections suggest crude ALD mortality will increase by 76% from 2021 to 2050 (354,200-624,150). Because alcohol exposure is frequently underreported, ascertainment using validated questionnaires and biomarkers is critical for surveillance and research. Scalable models linking alcohol-use detection with staged fibrosis assessment and triage pathways can narrow diagnostic gaps and support health system planning. Coupling these pathways with the implementation of high-impact "best-buy" alcohol control policies is essential to reduce the global ALD burden.