PREVALENCE AND MORTALITY OF ALCOHOL-RELATED LIVER DISEASES DURING COVID-19 PANDEMIC

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)