Jennifer Flemming, MD: Understanding the Shifting Burden of Alcohol-Associated Hepatitis

Alcohol-associated hepatitis (AH) is on the rise among adolescents and young adults, but long-term liver-related outcomes for affected individuals vary by sex, according to findings from a recent study.1

The population-based study of more than 3000 patients 13-39 years of age in Canada highlights rapid increases in the rates of AH in this patient population over the past 2 decades, especially among women. Additional analyses reveal female sex is independently associated with a 47% greater risk of cirrhosis and/or decompensation, and the cumulative incidence of liver-related mortality at 10 years is higher among women than men.1

According to alcohol-associated liver disease practice guidance from the American Association for the Study of Liver Diseases, women have a greater risk of liver injury compared with men for any level of drinking. Additionally, while rates of alcohol use disorder and high-risk drinking have grown in recent years, some of the greatest increases have been observed among women.2

“Myself, in addition to many others, noticed this switch in the demographic of individuals who were coming in with acute alcohol-associated hepatitis,” Jennifer Flemming, MD, an associate professor of medicine and public health sciences at Queen's University, told HCPLive, explaining how AH has historically been known to affect middle-aged men but has recently been observed more frequently in younger individuals, especially females.

To determine the extent of this phenomenon, she and a group of colleagues conducted a population-based retrospective cohort study of 3340 adolescents and young adults 13-39 years of age with an incident diagnosis of alcohol-associated hepatitis without a history of cirrhosis and/or decompensation in Ontario, Canada.

“What we found, concerningly, is that rates of [AH] were going up in all ages in this young group,” Flemming said. “When we stratified it based on sex, kind of similar to what we were seeing clinically, we saw that the rates were going up much higher among females.”

Flemming went on to emphasize the importance of multidisciplinary management of alcohol-associated liver disease and underlying alcohol use disorder, citing the importance of addressing both the liver-related and addiction aspects of these conditions. Additionally, she called attention to the need to develop sex-based interventions addressing the heightened risk of alcohol-associated liver disease observed in female patients.

Editors’ note: Flemming has no relevant disclosures.

References

1. Brooks A. Young Women Face Worse Long-Term Alcohol-Associated Hepatitis Outcomes Than Men. HCPLive. January 8, 2025. Accessed January 13, 2025. https://www.hcplive.com/view/young-women-face-worse-long-term-alcohol-associated-hepatitis-outcomes-than-men
2. Crabb DW, Im GY, Szabo G, et al. Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases. Hepatology. doi:10.1002/hep.30866