Alarming rise in alcohol‐associated liver disease hospitalization in young adults

BACKGROUND: Alcohol-associated liver disease (ALD) is increasingly affecting young adults, but comprehensive analyses of hospitalization patterns in this demographic remain limited. We aimed to evaluate trends in hospitalization rates, disease severity, and healthcare costs for ALD among adults aged 20-49 years compared with older adults. METHODS: We conducted a retrospective analysis using the National Inpatient Sample (2016-2022) to evaluate ALD-related hospitalizations in adults ≥20 years. Using ICD-10 codes, we identified hospitalization of ALD, alcohol-associated cirrhosis and alcohol-associated hepatitis, analyzing hospitalization rates, decompensation rates, and inflation-adjusted costs. Temporal trends were assessed using joinpoint regression analysis with results expressed as mean annual percentage change and Cochrane-Armitage test. RESULTS: Among 1,159,959 hospitalizations in young adults with ALD, rates increased more steeply compared to older adults (annual increase: 4.48% vs. 1.78%), rising from 106.5 to 144.7 per 100,000 persons versus 269.5 to 295.0 per 100,000 persons, respectively. By 2020, alcohol-associated hepatitis hospitalization rates in young adults surpassed older adults (65.6 vs. 61.3 per 100,000). The 30-39 age group represented the largest increase (31% to 37.5%) among young adults. Decompensated alcohol-associated cirrhosis increased across all age groups, most prominently in ages 20-29 (31.3% to 36.4%). National costs doubled from $1.69 billion to $3.45 billion. CONCLUSION: Young adults demonstrated accelerated increases in ALD-related hospitalizations and disease severity compared to older adults, with a particularly pronounced trend during the pandemic period. These findings suggest a need for age-specific preventive and therapeutic interventions.