A new study from Keck Medicine of USC shows a significant rise in alcohol-related liver disease over the last two decades, revealing critical demographic shifts and underscoring the urgent need for targeted interventions.
Heavy drinkers in the United States are now more than twice as likely to develop significant liver disease compared to two decades ago, according to a new study published today by Keck Medicine of USC in the journal Clinical Gastroenterology and Hepatology.
“Alcohol-related liver disease is the main cause of liver-related death and these results are a major wakeup call to the dangers of drinking,” lead author Brian P. Lee, a hepatologist and liver transplant specialist with Keck Medicine, said in a news release.
This comprehensive research sheds light on changing demographics among American drinkers, revealing that women, adults aged 45 and older, those living in poverty and individuals with metabolic syndrome now represent a larger share of heavy drinkers than two decades ago.
Previous studies have already linked these groups to a higher risk of liver disease when exposed to alcohol.
“These findings — the first comprehensive look at the demographics of heavy drinking and their relation to liver disease since the 1990s — provide important new information about which population groups may need more intervention to curb alcohol use and may also explain the rise in liver disease over the years,” added Lee.
The study also uncovered that, despite steady average drinking rates in America over the last 20 years (before the COVID-19 pandemic), the incidence of significant liver disease still increased. This suggests that changing health and demographic profiles, rather than just alcohol consumption levels, may be contributing to the spike in liver disease.
“Our results show that the makeup of the American public with heavy alcohol consumption has changed compared to 20 years ago,” Lee added.
Lee and his research team analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020, focusing specifically on the demographic and health profiles of adults aged 20 or older who drank heavily.
The Centers for Disease Control and Prevention (CDC) defines heavy drinking as eight drinks per week for women and 15 for men.
By tracking the total increase in significant liver disease — a condition where the liver forms scar tissue that impairs its function, often due to heavy drinking — the study provides critical insights needed for future health care interventions.
Lee hopes the study will prompt physicians to update their approaches to treating patients and lead to increased screenings and interventions for high-risk populations.
These findings build on Lee’s prior work, including a February 2025 study that found heavy drinkers with diabetes, high blood pressure or increased waist size had double the risk of advanced liver disease, and a November 2024 study revealing that heavy drinking surged during the COVID-19 pandemic’s peak and remained elevated for two years afterward.
Jennifer Dodge, an assistant professor of research medicine and population and public health sciences at the Keck School of Medicine of USC, also contributed to the study.
Source: Keck Medicine of USC