Severe alcohol-related liver disease common in younger Australians

Dylan Allen celebrated his 18th birthday with his friends and a few beers.

"It was something that seemed completely harmless at the time," his mother, Rachel Allen, said.

"I wasn't at all alarmed by this as Dylan had not touched alcohol as far as I knew up until this point."

But within about three months, Mr Allen's relationship with alcohol became concerning.

"He was drinking more than beer and in heavier, more dangerous amounts," Ms Allen said.

"His entire personality began to change from then on."

Between the ages of 20 and 25, Mr Allen was admitted multiple times to both private and public rehab programs, but Ms Allen said they provided temporary relief rather than a long-term solution.

In 2022, Mr Allen died at the age of 26 from alcohol-related liver disease.

A new report from the Burnet Institute, commissioned by the Foundation for Alcohol Research and Education (FARE) has found the number of people, including those in their 30s, diagnosed with alcohol-associated hepatitis has increased in recent years.

It found the rate of alcohol-associated hepatitis increased drastically in Victoria during the COVID-19 pandemic and had since remained elevated.

Young Australians at high risk

Alcohol-related liver disease typically has three stages:

• Fatty liver: where too much fat is stored in liver cells.
• Alcohol-associated hepatitis: swelling and damage in the liver caused by drinking too much alcohol.
• Alcohol-related cirrhosis: severe disease where the liver is extensively scarred.

Researchers at the Burnet Institute looked at how many people were hospitalised in Victoria with alcohol-associated hepatitis between January 2017 and June 2024.

They found that about half of the people with alcohol-related liver disease developed cirrhosis within six years.

The researchers then split the figures into three distinct time periods: pre-pandemic (up until February 2020); during the pandemic (March 2020 to October 2021); and post-pandemic (November 2021 onwards).

Lead author Jessica Howell, gastroenterologist at St Vincent's Hospital and head of the Institute's hepatitis and liver cancer group, said hospital admissions for both men and women increased "significantly" during the pandemic.

And while rates decreased slightly in post-pandemic years, Professor Howell said they remained higher than pre-pandemic levels, with young people emerging as an at-risk population.

"Between 2017 and 2024, around 40 per cent of admissions for alcohol-associated hepatitis occurred in people under the age of 45," Professor Howell said.

"Around 13 per cent end up in intensive care, and it has a 4 per cent mortality [rate]."

Jacob George, liver research scientist at the University of Sydney who did not contribute to the study, was unsurprised by the findings.

"The COVID lockdowns, which were particularly severe in Victoria, clearly contributed [to alcohol consumption]," he said.

"I suspect we would find similar effects across Australian states and territories."

And while data suggested young people were now drinking less than previous generations, Professor George said this was not the whole story.

"A smaller number of people are also drinking more, including binge drinking, resulting in harmful alcohol consumption and its adverse consequences,"

he said.

Researchers found people diagnosed with alcohol-related liver cancer in Victoria were younger than those diagnosed with other forms of liver cancer.

The report was retrospective, using information from two Victorian patient databases, but Professor George said a study that followed patients over time would capture more accurate data.

Spotlight on harm for women

Women now account for about one in three cases of alcohol-associated hepatitis in Victoria, according to the report.

Professor George said the finding was "very concerning"

During the pandemic when hospitalisations for women started to grow, Professor Howell theorised that women in Victoria often had an additional burden of care, typically juggling work, homeschooling children and other household responsibilities.

Even today, she said there were "very few" services that targeted the specific needs of women, particularly those who were balancing their own needs with care for others.

The report found women with alcohol-associated hepatitis were younger, more physically frail and more likely to require an ICU admission than men.

"Women have a smaller body mass, particularly muscle mass, than men and so the amount of alcohol that can lead to harm within the body is lower," Professor Howell said.

FARE chief executive Ayla Chorley said another big change was how alcohol was being directly marketed to women.

"You've got, mummy wine nights and terminology which is effectively saying: 'This is a good way for you to de-stress and you deserve it,'" she said.

"And we're seeing alcohol consumption in women increase and we're also seeing alcohol-related harms in women increase."

Stigma a 'critical barrier' to care

Professor Howell recommended that anyone concerned about their drinking habits should talk to a GP as early intervention could help reduce harm.

And it was never too late to cut back, she added.

"We know that the liver can regenerate very well.

"We're very fortunate that at any stage, if people reduce their alcohol consumption,they can really see very, very positive health benefits."

Professor Howell said small steps, like swapping every second drink for water or eating food while drinking, could make a big difference.

But she noted that people who came forward for help often faced stigma and discrimination, which could be a "critical barrier" to getting appropriate care.

It is a barrier Ms Allen, who watched her much-loved son struggle to get the help he needed, knows all too well.

She said better-coordinated and more compassionate care might have helped her son.

"He also often went to the GP with me and even though he presented as extremely unwell, he was basically not treated with dignity and respect," she said.

"Wherever he is, I know that the mental torment he went through while he was here is now over and that he can finally rest.