Increasing rates of alcohol related admissions during the COVID-19 pandemic

ABSTRACT

Background: During the Coronavirus Disease 2019 (COVID-19) pandemic, alcohol sales have increased and studies have reported an increase in binge-drinking behavior. This has led medical experts to forewarn of a rise in alcohol use disorder (AUD) and alcohol associated liver disease (ALD) as a consequence of the pandemic. We aim to observe the trends in alcohol-related hospital encounters as a result of the COVID-19 pandemic. Methods: Rates of inpatient hospital encounters from January 1, 2016 until May 1, 2021 were retrospectively evaluated in a large integrated health system in Northern California, including observation, admission and emergency department encounters. Diagnoses related to AUD and ALD, including alcohol dependence and withdrawal, alcoholic hepatitis, alcoholic cirrhosis, and alcoholic hepatic failure were included. Each encounter was categorized by admission month. Chi-squared tests were used to compare encounters from the pre-pandemic (March 2019-February 2020) era to the pandemic era (March 2020-February 2021). Results: Our study included 43,195 hospital encounters related to AUD/ALD, which represented 0.9% of all encounters during the study period. Mean age of patients was 51 (SD = 13.5), and 31% of visits were women. The race/ethnicity distribution was 62% White, 9% Black, 21% Hispanic, 3% Asian, 5% Other/Unknown. The highest rates of encounters were for alcohol dependence with withdrawal (23,725 [55%]), followed by alcoholic cirrhosis (17,671 [41%]), and alcoholic hepatitis (6,423 [15%]). When comparing pandemic to pre-pandemic era hospital encounters, rates of AUD/ALD encounters were higher in every month studied after March 2020 (Figure 1). The rate of AUD/ALD admissions was significantly higher during the pandemic (11.64 per 1000 encounters) compared to pre-pandemic (8.84, p<0.001). The sex distribution was similar during these two periods (30.9% vs. 31.1% female, p=0.809);the race/ethnicity distribution was also similar, but an increase in patients with Other/unknown race/ethnicity was observed (4.91% vs. 6.18%, p<0.001). Conclusion: We found a significant increase in the rate of hospital encounters related to AUD and ALD when comparing the pre-pandemic to the pandemic era. This may foreshadow an increased burden of AUD and ALD in the aftermath of the COVID-19 pandemic.