HOSPITALIZATIONS FOR ALCOHOLIC LIVER DISEASE DURING THE COVID-19 PANDEMIC INCREASED MORE FOR WOMEN, ESPECIALLY YOUNG WOMEN, COMPARED TO MEN

ABSTRACT

Background: The COVID-19 pandemic is alleged to have provoked more significant financial and emotional hardships on women compared to men. During the pandemic, liquor stores in the US were considered essential businesses and alcohol sales increased by > 34%. Although women have lower and less active alcohol dehydrogenase in the GI tract and liver, compared to men, alcoholic liver disease (ALD) has traditionally been a disease primarily of middle-aged and older men. The current study was designed to evaluate whether increased alcohol consumption during the COVID-19 pandemic resulted in an increase in ALD admissions, particularly in women. Methods: Admissions to a multi-hospital health system for ALD were compared for two periods (April 2019 – March 2020 (Pre-COVID, “PC”) and April 2020 – March 2021 (During-COVID, “COV”)). Admissions for ALD were identified by querying an electronic database (EPIC) using ICD-10 codes. Statistical data were analyzed using a Poisson Regression Model. Admission rates were compared using the annual quarterly average for the two time periods, and stratified by age and gender. Results: Comparing PC and COV admissions for ALD, an average quarterly increase of 33% (p=0.031) was detected in women <50 (75 PC;104 COV). During the same two periods, ALD admissions for males <50 increased 24% (p=0.043) (131 PC;166 COV). In women >50 there was an average quarterly increase of 22% (p=0.063) (131 PC;163 COV) in admissions for ALD, while a 24% (p=0.003) decrease was observed in males >50 (341 PC;267 COV). Males >50 remained the highest total admission group, but did have a significant proportional decline compared to the other groups. Total female admissions increased from 206 to 267, demonstrating an increase of 29% (p=0.005). Total male admissions decreased from 472 to 433;a 9% decrease (p=0.195). Total admissions for ALD showed a mild increase from 678 PC to 709 COV. Conclusions: The current study, comparing the PC and COV periods, demonstrates a significant increase in the number of ALD hospital admissions for both men and women <50. Importantly, a significant increase in the number of younger women requiring admission was identified. In women >50 a similar trend was observed, while a decrease in the number of admissions for ALD was detected in males >50. This study underestimates the prevalence of ALD during the COVID era, as only patients with significant ALD would have been admitted. Patient hesitancy to present to hospitals during the pandemic, as well as cessation of elective admissions may have also contributed. This large multi-hospital analysis demonstrates a concerning gender disparity with women, especially young women, being significantly more likely to be admitted with ALD during the COVID period compared to the twelve months prior to the pandemic. (Figure Presented)