*Purpose: The incidence of Alcoholic Liver Disease (ALD) has increased, causing ALD to become a primary indication for liver transplantation in the United States. We hypothesized an association between alcohol taxation and prevalence of ALD.

*Methods: We conducted a retrospective study of UNOS waitlist additions for liver transplantation between January 2007 and December 2016. We also analyzed the average excise tax (2007-2016) for beer, wine, and spirits in listing states of liver transplant waitlist additions (LTWA).

*Results: There were 104,805 adult UNOS LTWA with assigned diagnoses, an annual increase from 22 to 28 percent. There were 24,316 LTWA with the diagnosis of alcoholic liver disease. The mean value for beer tax was significantly lower for ALD patients than for non-ALD patients across all age groups (p<0.001). The analysis demonstrated significantly more ALD in waitlisted patients between the ages of 35-54 years (30%), compared with 18-34 years (10%) and ≥55 years (20%), p<0.001. The data confirmed significantly more ALD Medicaid patients in the 35-54-year age group (28%) compared with other age groups, p<0.001.

*Conclusions: Our research demonstrated an associated between lower beer tax and higher alcoholic liver disease prevalence across all age groups. We found a larger percentage of middle-aged (35-54 years) Medicaid patients listed with ALD. These findings raise the need for further investigation of a potential public health concern for an association between alcoholic liver disease and beer tax, especially for middle-aged patients of lower socioeconomic status.

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