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Dr. Elliot Tapper has treated a whole range of patients, but this one stood out.
"His whole body was yellow," recalls Tapper. "He could hardly move, it was hard for him to breathe, and he did not eat."
The patient had chronic liver disease. After years of drinking, his liver had stopped filtering his blood. Bilirubin, a yellowish waste compound, formed in his body and changed his skin color.
Disturbing for Tapper, the man was only in his mid-30s – much younger than most patients with liver disease.
Tapper, a The liver specialist and assistant professor of medicine at the University of Michigan Medical School tried to get the patient to stop drinking.
"We had long, tearful conversations," says Tapper, "but he continues to struggle with alcohol addiction." Since then, the condition of the young man has continued to deteriorate, and Tapper is not optimistic about his chances of survival.
There are patient stories like these that made Tapper investigate liver disease in young people. According to a study published by Tapper and a colleague on Wednesday, fatal liver disease has increased and young people are the most affected.
The study looked at the number of deaths due to liver cirrhosis or scarring liver cancer. The data came from the Centers for Disease Control and Prevention and covered the period from 1999 to 2016.
The analysis showed that deaths from liver disease have increased dramatically and death rates among young people have increased the fastest. Although these diseases can be caused by various factors such as obesity and hepatitis C, the increase among young Americans has been caused by alcohol consumption. The number of 25- to 34-year-olds who died of alcohol-related liver disease tripled between 1999 and 2016, almost from 259 in 1999 to 767 in 2016, an average annual increase of about 10 percent.
"What happens to young people? People are upset, to say the least," says Tapper.
Certain ethnic groups, such as whites and Native Americans, also saw a sharp increase in liver deaths in all age groups, while Asian Americans saw declines.
The increase in alcohol-related deaths overlaps with rising rates of binge drinking from 2002 to 2012 observed in much of the US
The authors noted a steep increase in mortality from 2009. The reason for the spike is unclear, but Dr. Neehar Parikh, a liver specialist at the University of Michigan Medical School and Tappers co-author, has a theory.
"It correlates with the global financial crisis," says Parikh. "We hypothesize that there may be a loss of opportunity, and the psychological burden that comes with it may have driven some of these patients into abusive alcohol use."
The rise among younger Americans is particularly worrying because it kills people prime of their lives.
"Every young patient who dies is a tragedy," says Parikh. "It's lost years of life."
The study is the latest to confirm that liver disease is increasingly prevalent. A report released Tuesday by the CDC shows that the age-adjusted mortality rate of liver cancer has risen 43 percent since 2000. A recent study by veterans found that cirrhosis cases nearly doubled between 2001 and 2013.
Dr. Vijay Shah, who heads the Department of Gastroenterology and Hepatology at the Mayo Clinic and has not been involved in this research, says the study's emphasis on young Americans is new.
Alcoholic cirrhosis was previously considered to be a disease that would occur after 30 years of heavy drinking, "says Shah," but this study shows that these problems actually occur in people in their 20s and 30s. "
" It There has been a shift in the type of patients we see, "agrees Dr. Sumeet Asrani, a liver specialist, on Dallas practitioners who did not contribute to the study." It fits in with what we see in practice , We're seeing younger patients with alcohol-related liver disease. "
Despite recent increases, cirrhosis remains a relatively small cause of death for young Americans and accounts for only 1.4 percent of total deaths in patients aged 25 to 34 years is much more important to the young Native Americans who account for 6.3 percent of the deaths.
Tapper believes the problem will only get worse, and some conditions that cause liver problems, such as hepatitis C, have dropped other risk factors, including obesity, are on the rise, and alcohol consumption and obesity may influence one another to aggravate liver disease, says Tapper.
Tapper believes politics could play a role in solving the problem Strategic taxation of alcoholic beverages discourage consumption, as does the increase tax on cigarettes can reduce smoking. He cites the example of Scotland, which has recently set minimum prices for alcohol units to prevent binge drinking. He also refers to public health measures, such as counseling, that help people stop drinking.
The good news is that liver disease is often reversible. Many patients can recover if they do not drink soon enough.
"I had patients who came to me in a wheelchair," says Tapper. "Three months later, they shovel snow and their lab tests are normal, it's always because they've made the choice to stop drinking."
Paul Chisholm is an intern at the NPR Science Desk.