Cases of alcohol-related liver disease rose by more than 60% from 2019 to 2021 in California and have not dropped back to pre-pandemic levels, according to findings presented at the AASLD  Liver Meeting. Another study showed that deaths due to alcohol-related liver disease and fatty liver disease have also increased.

Alcohol consumption increased during the initial years of the COVID-19 pandemic, contributing to rising rates of liver disease. Fatty liver disease and alcohol-related hepatitis have both grown increasingly common.

Following up on an earlier analysis of changes from 2019 to 2020, Aalam Sohal, MD, of the University of California Fresno, and colleagues assessed rates of severe alcohol-related hepatitis during the pandemic’s second year.

The team reviewed electronic medical records, looked at the number of alcohol-related hepatitis cases among people seen at three community hospitals in Fresno between 2019 and 2021, comparing demographics, clinical course and outcomes. The study included 547 people.  

From 2019 to 2021, alcohol-related liver disease rose significantly. Cases shot up from 131 in 2019 to 201 in 2020 (a 53% increase) and to 215 in 2020 (a 64% increase).

The numbers of people younger than 40 years with alcohol-related hepatitis rose from 30 in 2019 to 61 in 2020 and to 71 in 2021, representing 103% and 136% increases, respectively. Cases among women jumped from 24 in 2019 to 55 in 2020 and to 67 in 2021, indicating increases of 129% and 179%, respectively.

The number of rehospitalizations within a three-month period jumped from 18 in 2019 to 80 in 2021, more than a fourfold increase. During the same period, mortality rose from 20 to 26.

“We believe that this sustained increase in cases of alcohol-related hepatitis at our hospital system is reflective of a much larger national problem,” the researchers concluded. “Urgent public health interventions are needed at a national level emergently to prevent this rise in cases from becoming a new normal.”

Rising Mortality

In another study, Yee Hui Yeo, of Cedars-Sinai Medical Center in Los Angeles, and colleagues looked at the impact of the pandemic on people with liver disease in the United States. Using the Centers for Disease Control and Prevention’s WONDER database and the National Vital Statistic System, they estimated age-standardized mortality rates for liver disease between 2010 to 2021.

Between 2010 and 2021, more than 600,000 deaths related to chronic liver disease were reported: approximately 340,000 from alcohol-related liver disease, 200,000 from hepatitis C, 58,000 from non-alcoholic fatty liver disease (NAFLD) and 20,000 from hepatitis B.

Alcohol-related liver disease mortality rose by 4% for the entire study period but by 18% between 2020 and 2021. Death rates were significantly higher than predicted by trends for those years. NAFLD-related mortality rose by 15% between 2020 and 2021, again with higher death rates during the pandemic. In contrast, deaths related to hepatitis B declined by about 2% and hepatitis C–related deaths fell by about 3%.

Men and women both saw sharp rises in alcohol-related liver disease mortality between 2019 and 2021, while NAFLD-related mortality for both sexes rose steadily from 2010 to 2021. People in the 25 to 44 age group saw the steepest rise in mortality due to alcohol-related liver disease during the pandemic (a 35% rise). Young people also had the largest increase in NAFLD-related deaths (a 28% rise). Native Americans and Alaska Natives had the largest increase in alcohol-related liver disease mortality, followed by white and Black people.

Mortality for alcohol-related liver disease and NAFLD “increased at alarming rates during the COVID-19 pandemic,” the researchers concluded.

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