ALCOHOL-RELATED liver diseases, particularly cirrhosis, have become a major global public health concern, with their impact varying across demographic groups. While traditionally more prevalent in men, recent research highlights a concerning rise in alcohol-related cirrhosis (AC) among women, particularly younger women and vulnerable populations such as Native Americans. This shift is attributed to both biological and societal factors, necessitating urgent intervention to address the growing burden.
Biologically, women are more susceptible to alcohol-induced liver damage due to metabolic differences. Lower gastric alcohol dehydrogenase activity results in higher blood alcohol levels for women than men after consuming the same amount of alcohol. Women consuming 40g/day of alcohol have a relative risk of 9.35 for developing liver cirrhosis, compared to 2.82 for men. Additionally, oestrogen exacerbates liver inflammation and accelerates fibrosis, further increasing susceptibility. The risk is magnified with age, especially post-menopause, when the protective hormonal effects diminish, making older women particularly vulnerable.
Societal factors also contribute significantly to the increasing incidence of AC in women. Alcohol marketing strategies often target women, linking heavy drinking to empowerment and social acceptance. The “wine mum” culture, which normalises excessive alcohol consumption, further perpetuates harmful drinking behaviours. These influences, combined with biological vulnerabilities, have led to an alarming rise in AC cases among women worldwide.
A recent study analysing data from the Global Burden of Disease (GBD) study from 1992–2021 provides valuable insight into the evolving trends of AC in women. Globally, the age-standardised incidence rate (ASIR) of AC in women declined slightly from 3.10 per 100,000 in 1992 to 2.42 per 100,000 in 2021. However, this decline was inconsistent across regions. High-SDI countries saw the greatest reductions due to advanced healthcare systems and effective alcohol control policies, such as taxation and minimum unit pricing. Conversely, lower-SDI countries experienced stagnation or slower declines, with persistently high disease burdens due to inadequate healthcare infrastructure and public health interventions.
Countries with strict alcohol regulations, such as Kuwait, exhibited significantly lower AC rates, whereas regions with cultural and socioeconomic challenges, like Mongolia and Central Asia, reported alarmingly high incidence and mortality rates. These disparities underscore the influence of policy, healthcare access, and cultural norms in shaping the disease burden.
Projections indicate a gradual decline in global AC rates among women by 2030. However, targeted interventions remain crucial to mitigate the disease burden effectively. Public health measures focusing on reducing alcohol consumption, raising awareness, and improving treatment access are essential to addressing this pressing health crisis among women.
Reference
Zhang Z et al. Global, regional, and national burdens of alcohol-related cirrhosis among women from 1992 to 2021 and its predictions. Sci Rep. 2025;15(1):10959.
