ABSTRACT
Background: Data have shown an increase in alcohol use during the COVID-19 pandemic in North America. While the total number of emergency department (ED) visits decreased during the early pandemic, some studies show that the proportion of alcohol-associated visits increased during this time. There is otherwise a paucity of data on how potentially increased alcohol use during the pandemic has affected healthcare utilization and patient outcomes, especially in patients with liver disease. Methods: Clinical records from a tertiary hospital in Ontario, Canada were reviewed for all adult patients encounters in the ED, urgent care, or inpatient setting for alcohol-associated reasons between April 2019 and October 2019 (pre-pandemic cohort) and between April 2020 and October 2020 (pandemic cohort). Data collected included: age, sex, marital status, rurality and socioeconomic status (by postal code-linked national census data), medical history, alcohol consumption habits, use of medications for alcohol use disorder, alcohol-associated diagnosis (based on ICD-10 code), need for intensive care unit admission, consultations made, discharge disposition, and laboratory results. Bivariate chi-squared analysis was performed to compare data from the pre-pandemic and pandemic cohorts. Results: 528 records in the pre-pandemic cohort and 490 records in the pandemic cohort were ed and summarized (Tables 1 and 2). As compared with the pre-pandemic cohort, patients during the pandemic presenting with alcohol-associated diagnoses were older (43 years, IQR 31-57 vs. 38 years, IQR 24-55;p<.001), more likely to be male (66% vs. 55%;p=.001), have a prior history of habitual heavy alcohol use or alcohol use disorder (77% vs. 63%;p<.001), have a history of a psychiatric disorder (56% vs 46%;p=.003), and to have been previously prescribed medication for alcohol use disorder (18% vs. 5%;p<.001). In the pandemic cohort, there was a greater proportion of encounters for alcohol withdrawal (32% vs. 22%;p=.001), a lower proportion of encounters for alcohol intoxication (46% vs. 56%;p<.001), and a similar proportion of encounters for alcohol-associated liver disease (8% vs. 7%;p=.651) compared to the pre-pandemic cohort. Conclusion: Our data show differences in patient characteristics for patients presenting to hospital for alcohol-associated reasons during the COVID-19 pandemic. As compared with the year before the pandemic, patients were older, more often male, and more likely to have history of psychiatric disorders or heavy alcohol use. One concerning finding was a significant rise in alcohol withdrawal, which could potentially be due to increased consumption of alcohol during the pandemic. These data raise concern for an increase in prevalence of alcohol-associated liver disease in the future, highlighting the need for enhanced alcohol addiction services. (Table Presented)
ABSTRACT
Background: Canadian provinces initiated states of emergency (SoE) between March 13 and March 23 2020 due to community transmission of COVID-19 We explore changes in self-reported quality of life (QoL) in patients with PBC early-on during SoE Methods: Patients with PBC from the Canadian Network for Autoimmune Liver disease who completed QoL questionnaires between July 2019 and June 2020 are included Questionnaires include the Short-Form 36 (SF-36), PBC-40, and Itch Numeric Rating Scale (iNRS) Measurements during SoE are after March 17 2020, date of SoE initiation in Ontario Measurements before Feb 1 2020 are pre-SoE Measurements between Feb 1 and March 16 2020 are excluded given growing societal concern during this time, but no formal SoE Analyses include mixed effects regressions of QoL scores with SoE as a binary variable Models are adjusted for duration of disease and age at diagnosis and employ random intercepts at clinic and patient level Results: 312 patients were included from Toronto (64%, n=198), Montreal (14%, n=43), Edmonton (7 7%, n=24), Ottawa (5 8%, n=18), Saskatoon (5 4%, n=17), and Kingston (3 8%, n=12) The majority of patients were female (93%, n=291), Caucasian (82%, n=256), and born in Canada (78%, n=242) Mean age was 58 6 years (SD 10 8), mean age at diagnosis was 49 3 years (SD 11 0), mean duration of disease was 9 0 years (SD 7 2), and 6 4% (n=20) had overlap with autoimmune hepatitis Patients had a mean of 1 3 (SD 0 5) repeated measures (maximum 3) 219 patients had measures pre-SoE and 128 had measurements during SoE Estimated mean SF-36 physical component scores were similar before and during the first 3 months of SoE (41.9 vs 40.7, p=0.16), as were SF-36 mental component scores (43 3 vs 43 5, p=0 91) When compared to average Canadian population SF-36 scores, patients with PBC had significantly worse scores before and during SoE (p<0 001 all comparisons) PBC-40 domain scores remained stable, with estimated mean values before and during SoE as follows: Symptoms 13 8 vs 14 2 (p=0 32), Fatigue 24 9 vs 25 0 (p=0 81), Cognitive 10 8 vs 11 1 (p=0 47), Socio-Emotional 25 4 vs 26 2 (p=0 20), Itch 4 7 vs 4.9 (p=0.44). There was a small but statistically significant increase in estimated mean iNRS score, from 2 4 pre-SoE to 3.3 during the first 3 months of SoE (p<0.001). Conclusion: Quality of life scores remained largely stable during the first three months of Canada's SoE SF-36 scores in patients with PBC were significantly worse than Canada's general population Analyses should be updated as Canada's SoE continues.
ABSTRACT
Background: Between March 13th and March 22nd, 2020, a state of emergency (SoE) was declared across Canada due to transmission of COVID-19 We compare self-reported quality of life (QoL) changes between Autoimmune Hepatitis (AIH) and Primary Biliary Cholangitis (PBC) patients during the first 3 months of SoE. Methods: Patients with an AIH or PBC diagnosis from the Canadian Network for Autoimmune Liver disease with completed QoL surveys between July 2019 and June 2020 were included in the analysis Surveys completed after March 17th, 2020 were categorized as during SoE, and data prior to February 1st, 2020 were categorized as before SoE. Domain-specific QoL measurements included the Short-Form 36 (SF-36) and Itch Numeric Rating Scale (NRS) Multiple linear mixed effect regressions and estimated marginal means compared PBC and AIH scores before and during the SoE, adjusting for age at diagnosis, duration of disease, and site Results: Of the total 456 participants included in the analysis, 63 3% had PBC Participants included were from six liver clinics across Canada: Toronto (AIH= 131, PBC =186), Montreal (PBC = 39), Edmonton (AIH= 2, PBC = 24), Saskatchewan (AIH = 13, PBC =17), Ottawa (AIH = 8, PBC = 14), and Kingston (AIH = 12, PBC = 9) Females accounted for 86 2% (n=393) of the cohort, and 78 9% (n=360) of participants were Caucasian Medians for age at diagnosis and age at SoE were 49 2 years [IQR 37 8- 57 8] and 58 3 years [48 7-66 4], respectively AIH patients were on average 7 years younger than PBC patients There were 316 assessment completed before the SoE (65% PBC) and 185 during (62% PBC). There were no significant differences in estimated mean SF-36 Physical component between diseases across time (Pre: AIH= 40 9 vs PBC= 41 8, p =0.9 vs During: 43.1 vs 40.7, p=0.49). Similar findings were observed in the SF-36 Mental component pre-SoE (p=0 78) and post-SoE (p=0 9) Overall, QoL scores in AIH remained stable across time Both patients with AIH and PBC reported lower SF-36 scores compared to the general Canadian population (p<0 001) Longer disease duration and older age at diagnosis were associated with better SF-36 scores, regardless of SoE (p<0 001) Estimated mean NRS scores for PBC were significantly worse than AIH, both before SoE (AIH= 1 7 vs PBC=2 63, p<0 05) and during SoE (AIH = 2 26 vs PBC= 3 62, p<0 01) Conclusion: Physical and mental QoL components remain stable for both patients with AIH and PBC, and we observed expected differences in itch between diagnoses.