ABSTRACT
BACKGROUND: Global pandemic of COVID-19 represents an unprecedented challenge. COVID-19 has predominantly targeted vulnerable populations with pre-existing chronic medical diseases, such as diabetes and chronic liver disease. AIMS: We estimated chronic liver disease-related mortality trends among individuals with diabetes before and during the COVID-19 pandemic. METHODS: Utilizing the US national mortality database and Census, we determined the quarterly age-standardized chronic liver disease-related mortality and quarterly percentage change (QPC) among individuals with diabetes. RESULTS: The quarterly age-standardized mortality for chronic liver disease and/or cirrhosis among individuals with diabetes remained stable before the COVID-19 pandemic and sharply increased during the COIVD-19 pandemic at a QPC of 8.5%. The quarterly mortality from nonalcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD) increased markedly during the COVID-19 pandemic. Mortality for hepatitis C virus (HCV) infection declined with a quarterly rate of -3.3% before the COVID-19 pandemic and remained stable during the COVID-19 pandemic. While ALD- and HCV-related mortality was higher in men than in women, NAFLD-related mortality in women was higher than in men. CONCLUSIONS: The sharp increase in mortality for chronic liver disease and/or cirrhosis among individuals with diabetes during the COVID-19 pandemic was associated with increased mortality from NAFLD and ALD.
ABSTRACT
Therapeutic Area ASCVD/CVD in Special Populations Background An ICD-10 code for Familial Hypercholesterolemia (FH), E78.01, became effective October 2016 following a proposal by the Family Heart Foundation. It differentiated FH from other forms of elevated cholesterol with a goal of increasing assessment of this treatable genetic condition. Prior to E78.01, <1% of FH patients in the US were diagnosed (Nordestgarrd, 2013). This study aims to characterize the current number and percent of FH patients diagnosed with E78.01 in an expansive, real-world US dataset. Methods The Family Heart Database includes 197 million people including 22 million children with diagnostic data from claims who were screened or treated for any form of cardiovascular risk from October 2016 through June 2020. Patients with FH (E78.01) were counted if the diagnostic code was applied for a single in-patient claim or at least twice, >7 days apart, for an out-patient claim. The number of total (diagnosed + undiagnosed) FH patients within the dataset was estimated assuming an occurrence of 1:250 individuals. Results Patients diagnosed with FH using E78.01 has increased substantially since 2016. During 2017 and 2018, use of the code was brisk and likely included previously and newly diagnosed individuals. Diagnosis was reduced dramatically with the onset of the COVID-19 pandemic corresponding with the marked reduction of in-person clinic visits and near halting of preventive care. By June 2020, 246,689 FH patients were diagnosed representing 31.3% of the estimated total (diagnosed + undiagnosed) FH population of 787,886 within the dataset. At the time of E78.01 code assignment, 52% of diagnosed FH patients were female;51% were aged 18 to 65 years, 47% were >65 years;they were Black (8%), Hispanic (5%), White (54%), and Other/Unknown (33%);40% had ASCVD and household income ranged from <$30K (13%) to >$100K (20%). Conclusion The number of patients diagnosed with FH (E78.01) has increased substantially since 2016. Within this large, real-world dataset of Americans, 31.3% of the estimated FH population had been diagnosed as of Jun 2020. However, most FH patients remain undiagnosed, delaying treatment and cascade screening. The rate of diagnosis was also hampered by the COVID-19 pandemic.