{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T03:02:11Z","timestamp":1792638131570,"version":"4.5.0"},"reference-count":65,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23AR079035 (SCG)"],"award-info":[{"award-number":["K23AR079035 (SCG)"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NIH\u2010K08DA061258"],"award-info":[{"award-number":["NIH\u2010K08DA061258"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NIH\u2010K23DA053433 (JKB)"],"award-info":[{"award-number":["NIH\u2010K23DA053433 (JKB)"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcohol, Clinical and Experimental Research"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Deaths from alcohol\u2010related liver disease and associated conditions (ALD+), a major driver of alcohol\u2010attributable mortality in the United States, are rising more rapidly than per capita alcohol consumption. These trends may stem from a broader \u201cdeaths of despair\u201d epidemic disproportionately affecting those without a college degree. However, how ALD+ mortality trends vary by educational attainment remains underexplored. To address this, we analyzed ALD+ mortality from 2001 to 2020, focusing on disparities across educational and demographic subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed US mortality trends for adults 25 and older using a repeated cross\u2010sectional dataset combining death records for ALD+ with population data from the American Community Survey. We examined differences in mortality trends by age, sex, race\/ethnicity, and educational attainment (college degree or not). Trends were modeled using logistic regression with age as a covariate and quadratic time terms. Outcomes included proportional change in mortality (odds ratios for 2020 vs. 2001), modeled age\u2010adjusted death rates for 2001 and 2020, and absolute change in death rate (\u0394).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2001 and 2020, the ALD+ death rate increased by 63% (OR\u2009=\u20091.63; 95% CI: 1.55, 1.72), from 8.8 to 16.6 deaths per 100,000. Increases were greater among individuals without a college degree compared to those with a college degree (\u0394\u2009=\u200912.7 vs. 2.4 per 100,000). Disparities by education widened across nearly all demographic groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Disparities in ALD+ mortality by educational attainment widened substantially between 2001 and 2020. Findings are partially consistent with the \u201cdeaths of despair\u201d framework that initially focused on mortality among middle\u2010aged non\u2010Hispanic Whites but also reveal widening disparities in other demographic groups. Increased alcohol consumption alone is unlikely to fully explain these trends. Identification of social, behavioral, and medical factors contributing to increasing ALD+ deaths will shed light on opportunities for intervention focused on factors beyond alcohol consumption.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acer.70194","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T15:01:06Z","timestamp":1764342066000},"page":"2754-2765","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Educational disparities in alcohol\u2010related liver disease mortality in the 21st century: Beyond deaths of despair?"],"prefix":"10.1111","volume":"49","author":[{"given":"Richard A.","family":"Grucza","sequence":"first","affiliation":[{"name":"Department of Family Saint Louis University School of Medicine  St. Louis MO USA"},{"name":"Department of Community Medicine Saint Louis University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel Jihwan","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Family Saint Louis University School of Medicine  St. Louis MO USA"},{"name":"Department of Community Medicine Saint Louis University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey F.","family":"Scherrer","sequence":"additional","affiliation":[{"name":"Department of Family Saint Louis University School of Medicine  St. Louis MO USA"},{"name":"Department of Community Medicine Saint Louis University School of Medicine  St. Louis MO USA"},{"name":"Department of Psychiatry Saint Louis University School of Medicine  St. Louis MO USA"},{"name":"Department of Behavioral Neuroscience Saint Louis University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer K.","family":"Bello","sequence":"additional","affiliation":[{"name":"Department of Family Saint Louis University School of Medicine  St. Louis MO USA"},{"name":"Department of Community Medicine Saint Louis University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah C.","family":"Gebauer","sequence":"additional","affiliation":[{"name":"Department of Family Saint Louis University School of Medicine  St. Louis MO USA"},{"name":"Department of Community Medicine Saint Louis University School of Medicine  St. Louis MO USA"},{"name":"The Advanced Health Data (AHEAD) Research Institute Saint Louis University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruizhi","family":"Huang","sequence":"additional","affiliation":[{"name":"The Advanced Health Data (AHEAD) Research Institute Saint Louis University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Salas","sequence":"additional","affiliation":[{"name":"The Advanced Health Data (AHEAD) Research Institute Saint Louis University School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6595-695X","authenticated-orcid":false,"given":"Kevin Young","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Washington University School of Medicine in St. Louis  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1701443"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13408"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jflm.2021.102220"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510230513"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191912395"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(20)30119-5"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2019.07.001"},{"key":"e_1_2_10_9_1","unstructured":"Brown J.&Dragojevic A.(2024)Alcohol consumption guidelines: a warning shot for the industry. 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