Dear Editor,
We sincerely appreciate Dr. Kim’s thoughtful commentary on our recent publication, “Sex disparities in alcohol-associated liver disease and subtype differences in alcohol-attributable cancers in the United States” [
1,
2]. The editorial effectively underscores the pressing need to address the increasing burden of alcohol-associated liver disease (ALD) and alcohol-attributable cancer.
Indeed, the global toll of alcohol misuse is staggering, contributing to millions of deaths annually. While prior studies had emphasized the rising incidence of alcohol use disorder (AUD) in females [
3], our study added to this literature by showing that ALD is also disproportionately [
1]. The GBD 2021 estimates mark the first time in the GBD cycle that trends could be evaluated, including during the coronavirus disease 2019 (COVID-19) pandemic period [
1,
4]. The COVID-19 pandemic significantly disrupted routine healthcare services, leading to delays in detecting and managing chronic conditions, including ALD. According to data from the National Vital Statistics System database, ALD-related mortality in the U.S. rose sharply during the early phase of the COVID-19 pandemic [
5]. This sharp rise during the early phase of the pandemic was noted across all racial and ethnic groups except non-Hispanic Asian individuals and both sexes [
6]. Moreover, data from the latest National Health and Nutrition Examination Survey showed that the prevalence of advanced fibrosis in SLD was significantly higher during the COVID-19 pandemic [
7]. This increase was likely exacerbated by heightened alcohol consumption during this period, further compromising liver health in the U.S. population. The disproportionate increase in ALD among females found in our study is concerning, as females are more biologically vulnerable to the effects of alcohol than males [
3]. These changes have implications beyond liver disease, as alcohol is a known carcinogen implicated in liver, breast, and aerodigestive tract cancers [
8,
9].
Addressing these intertwined problems requires targeted research into systemic barriers that hinder care access, along with strengthening alcohol-related policy. A prior ecological study showed that a significant drop in ALD mortality occurred four years after policy establishment, and liver cancer-related improvements emerged at 7–8 years, reinforcing a crucial message: public health policies may not yield immediate dividends but can reshape population health over time [
10]. Tackling this crisis requires a comprehensive approach at multiple levels. At the individual level, clinicians can screen for alcohol use and facilitate referrals to behavioral therapy, addiction medicine, and social services [
11]. Embedding social workers or patient navigators within liver and cancer clinics may help address barriers to care and promote adherence. At the community level, public education campaigns that target stigma and raise awareness about the carcinogenic risks of alcohol can promote informed decision-making [
12]. At the policy level, interventions such as taxation, reduced hours of alcohol sales, and restricting marketing have demonstrated impact. Success will require coordinated efforts across stakeholders which is essential to promote alcohol cessation, early detection, timely intervention, and widespread awareness of alcohol-related harm, including ALD and alcohol-attributable cancer [
13,
14]. Moreover, efforts to reduce concomitant risk factors of SLD, such as metabolic risk factors, need to be executed [
4,
15].
Collectively, these efforts represent a necessary shift from passive recognition of epidemiologic trends to proactive, sustained intervention. By integrating clinical, community, and policy strategies, we can meaningfully reduce the burden of ALD and alcohol-attributable cancers and promote population health.
FOOTNOTES
-
Authors’ contribution
Writing, original draft – Pojsakorn Danpanichkul, Karn Wijarnpreecha. Writing, review, and editing – Donghee Kim, Ju Dong Yang, Amit G. Singal. All authors have read and approved the final version of the manuscript for submission.
-
Conflicts of Interest
Amit G. Singal has served as a consultant or on advisory boards for Fujifilm Medical Sciences, Exact Sciences, Glycotest, Roche, Abbott, DELFI, GRAIL, Genentech, AstraZeneca, Eisai, Bayer, Exelixis, Merck, Elevar, Boston Scientific, Sirtex, and HistoSonics. Ju Dong Yang consults for AstraZeneca, Eisai, Exact Sciences, and FujiFilm Medical Sciences.
Abbreviations
alcohol-associated liver disease
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