ABSTRACT
Background COVID-19 pandemic and its resulting life stress could affect lifestyle including increased alcohol use. Mounting evidence has indicated rising prevalence in alcohol related liver disease (ALD) during pandemic. However, the studies were limited by single center data with cross-sectional design. We aimed to determine the nationwide effect of COVID- 19 pandemic on the prevalence as well as mortality of ALD among patients with alcohol use disorder (AUD). Methods Patient data were obtained from the Optum de-identified Clinformatics® database. Enrollees with a diagnosis of AUD who received care in hospital emergency department and/or inpatient service from January 2019 to December 2020 were included and followed up until March 2021. AUD were defined as having alcohol intoxication, withdrawal, and alcohol-related mental health disorders. We estimated the quarterly prevalence and 30-, 60-, 90-, and 180-day mortality during study period. Results There were no significant trends in mortality before the pandemic. The 30-day mortality decreased from 11.96% to 10.34% from Q1 to Q3 in 2019, then increased to 12.10% in Q1 2020. The increase between 2019 Q1 and 2020 Q1 was not significant. In contrast, the mortality rates increased from 2020 Q1 to 2020 Q2 and continued to increase during pandemic. Mortality rate elevated from 12.10% to 13.44% from 2020 Q1 to 2020 Q2, followed by 13.50% in Q3 and 14.94% in Q4. Similar pattern was seen in 60-day and 90-day mortalities. About a quarter of patient died at 90 days after diagnosis of ALD. The prevalence of ALD among patients with AUD fluctuated throughout 2019, with 53.77% in 2019 Q1 decreasing to 51.29% in 2019 Q3. It increased to 53.15% in 2019 Q4. The prevalence was higher in 2020 Q1 compare to 2019 Q1. However, during pandemic, the prevalence decreased to 53.98% in 2020 Q2 then bounced to 55.40% and 56.57% in 2020 Q3 and Q4. While the prevalence of ALD in AUD patients who visited ED increased from 2020 Q2 to 2020 Q4, the prevalence of ALD in hospitalized patient surged in 2020 Q2, followed by decreasing trend in latter half of 2020. The increasing trend was more prominent in patients aged <65 years than those $65 years. Males had a steeper increasing trend than females. While there was no significant change in prevalence of ALD among non-Hispanic Asians, the upward trend among non-Hispanic Whites and Blacks was significant. ConclusionsWedemonstrated an alarming rise in ALD mortality and increased prevalence among patients with AUD. The data were derived from patients with private insurance. Trends in those without insurance or less coverage are expected to be more alarming given the limitation in access to care. There were significant disparities by sex and race and ethnicity that may inform stakeholders for targeted interventions and resource allocation to curb the surging burden of ALD during pandemic. (Table Presented)
ABSTRACT
Introduction: The COVID-19 pandemic has dramatically imperiled the health system worldwide. It may also negatively impact the cascade of care of hepatitis C virus (HCV) infection and the progress on WHO 2030 goal of HCV elimination. In this study, we used a multinational, multicenter cohort to estimate the change in the completion of DAA therapy, HCV RNA testing, and clinical encounter during pandemic. Methods: We collected data patients who underwent DAA therapy at three tertiary medical centers in Los Angeles (US), Xi'an (China), and Nanjing (China) between January 1, 2019 to June 30, 2020 and followed until November 30, 2020. We compared the proportions of HCV patients who completed DAA therapy as well as had HCV RNA testing and follow-up visits during and after the end of the HCV therapy between COVID-19 pandemic and the periods before pandemic. Additionally, we determined the frequency and predictive factors of utilization of telemedicine. Results: A total of 256 patients with HCV infection were included. Despite no significant reduction in the completion of DAA before and during the pandemic, the proportion of patients undergoing HCV RNA testing during DAA treatment decreased from about 80% before pandemic to 67% during the pandemic, with a more prominent decrease in the US. There were less than 10% of patients who had HCV RNA testing 12 weeks post-treatment during COVID-19 era. Compared to pre-pandemic period, post-treatment clinic encounter decreased significant in China but elevated in the US. Further analysis showed that the increase was due to the surge in utilization of telemedicine. However, the increased number of follow-up visits during COVID-19 pandemic period did not result in an increase in HCV RNA testing. Conclusion: COVID-19 pandemic carried profound impact on the cascade of care for HCV patients in both the US and China. Despite the increased use of telemedicine in the US, the adherence to recommendations for HCV RNA testing was still disappointingly low. Stakeholders should identify the modifiable barriers and reinforce the care while withstanding the pandemic.