Table 2.
Studies exploring the impact of the COVID-19 pandemic on alcohol consumption and alcohol-associated liver disease.
| Author (Year)Ref. | Primary outcome | Study Design | Study Population | Main Study Findings |
|---|---|---|---|---|
| Alcohol Consumption and Alcohol-Related Complications | ||||
| Jackson et al. (2021) [9] | High-risk alcohol consumption | Cross-sectional survey | Adults ≥ 16 years old living in England (N = 20,558) |
High-risk alcohol use increased from 25% in April 2019-February 2020 to 38% in April 2020, and use of evidence-based treatment declined (4.0% to 1.2%). |
| Lee et al. (2021) [7] | Alcohol sales | Nielsen National Consumer Panel prospective cohort study | Households in the contiguous United States (N = 144,704 households) | Alcohol sales from April-June increased from $7.1 billion in 2018 to $9.55 billion in 2020. |
| Sharma et al. (2021) [10] | Alcohol-related hospitalizations | Retrospective Cohort | Hospitalizations for alcohol withdrawal at a tertiary hospital in Delaware (N = 847) | 34% increase in hospitalizations for alcohol withdrawal at the end of stay-at-home orders in 2020 compared to 2019. |
| White et al. (2022) [11] | Alcohol-related deaths | Cross-sectional | United States mortality data from the National Center for Health Statistics | Alcohol-related deaths increased 26% from 2019 to 2020, largest increases in adults aged 35 to 44 years (40%) and 25 to 34 years (27%). |
| Alcohol-Associated Liver Disease Burden | ||||
| Deutsch-Link et al. (2022) [27] | ALD mortality | Cross-sectional | United States mortality data from the National Center for Health Statistics | From 2019 to 2020, ALD-related mortality increased 21% in males and 27% in females. Highest relative increases observed in those under age 45. |
| Gonzalez et al. (2022) [24] | AH hospitalizations | Retrospective cohort | Hospitalizations for AH at a tertiary hospital in Michigan (N = 337) | AH admissions increased 50% in 2020 from 2016 to 2019. |
| Görgülü et al. (2022) [32] | ICU admissions for ACLF | Retrospective cohort | ICU admissions for ACLF in Germany (N = 237) | From 2017–2019, 24–27% of ICU admissions for ACLF were from AH; in 2020, 57% of ACLF admissions were from AH. |
| Julien et al. (2021) [23] | ALD Burden | Microsimulation modeling study | US adults born between 1920 and 2012 | Increased alcohol use during the pandemic is projected to result in 8000 additional ALD deaths and 18,7000 additional cases of decompensated cirrhosis between 2020 and 2040. |
| Shaheen et al. (2022) [28] | AH and AC hospitalizations | Retrospective cohort | Adult hospitalizations for AH or AC in Alberta, Canada. (N = 6642) | Average monthly admissions for AH increased from 11.6/10,000 admissions before March 2020 to 22.1/10,000 admissions after. AC hospitalizations were stable. |
| Sohal et al. (2022) [25] | AH hospitalizations | Retrospective cohort | Hospitalizations for AH at 2 community hospitals in California (N = 329) | AH admissions increased 51% between 2019 and 2020, 100% increase in patients < 40 years, and 125% increase in female patients. |
| COVID-19-related Outcomes | ||||
| Belli et al. (2021) [47] | COVID-19 outcomes in LT candidates and post transplant outcomes | Prospective cohort study | Adult patients listed for LT who contracted COVID-19. Multi-center study at 149 transplant centers across Europe. (N = 113) | Mortality in LT candidates from COVID-19 was 33% (45% in decompensated cirrhosis). Prior COVID-19 infection did not impact early post-transplant survival. |
| Iavarone et al. (2020) [36] | Cirrhosis and COVID-19 outcomes | Multi-center retrospective cohort study | Hospitalized patients with cirrhosis and COVID-19 across 9 hospitals in Northern Italy from March 1st-31st 2020 (N = 50) | Out of 50 patients with cirrhosis and COVID-19, 28% of patients developed ACLF and the 30-day mortality was 34%. |
| Kulkarni et al. (2021) [52] | COVID-19 outcomes in LT recipients | Systematic Review and Meta-Analysis | Meta-analysis of 18 studies with 1522 LT recipients infected with COVID-19 (December 2019-May 2020) | Mortality in LT recipients was 17.4%. Mortality in LT recipients was similar to non-LT recipients after adjusting for age and comorbidities. |
| Marjot et al. (2021) [39] | CLD and COVID-19 outcomes | Multi-center international cohort study | Patients with CLD > 16 years old with COVID-19 (N = 745) | Case fatality rate for patients with ALD was 36%, the highest of any CLD etiology. Case fatality rate for CP-A, B, and C cirrhosis was 24%, 35%, and 54%, respectively. |
| Wang et al. (2021) [35] | SUD and risk of COVID-19 | Retrospective case control study | US EHR data from IBM Watson Health Explorys (N = 73,099,850) | History of AUD in the past year was associated with an increased risk of contracting COVID-19 (AOR=7.75). Patients with any SUD had increased risk of death (9.6% vs 6.6%) and hospitalization (41% vs 30%) compared to general COVID-19 patients. |
| ALD Treatment and Liver Transplantation | ||||
| Anderson et al. (2021) [45] | Liver Transplantation for AH | Retrospective cohort study | Adults registered in the UNOS database | From June 2020 to January 2021, wait-list registrations for AH increased by 60% and transplants for AH increased by 62%. |
| Bittermann et al. (2021) [43] | Liver Transplantation for AH | Retrospective cohort study | Adults registered in the UNOS database | From March 2020 to February 2021, AH listing increased by 107% and AHD liver transplants increased by 210%. |
| Cholankeril et al. (2021) [43] | Liver Transplantation for ALD | Retrospective cohort study | Adults registered in the UNOS database | ALD listing increased by 7.3% and ALD transplants increased by 10.7% during the pandemic, with ALD accounting for more listings (40.1%) than HCV (12.4%) and NASH (23.4%) combined. |
| Mahmud et al. (2020) [40] | CLD Hospitalizations | Retrospective cohort study | VA patients ≥ 18 years of age hospitalized for any reason between January 1st-April 15 in 2019 and 2020 (N = 12,467 hospitalizations) | During the first few weeks of the pandemic, cirrhosis-related hospital admissions declined by more than 50%. Hospitalizations had significantly higher MELD-Na. |
| Demographic Trends and Disparities | ||||
| Adeniji et al. (2021) [60] | COVID-19 in and socioeconomic factors in patients with CLD | Retrospective cohort study | Adults ≥ 18 years old and a diagnosis of CLD diagnosed with COVID-19 across 21 medical centers in the US from March-May 2020. (N = 909) | Black and Hispanic patients with CLD were more likely to contract COVID-19 compared to White patients with CLD. Black and Hispanic patients were less likely to have private insurance, and were more likely to experience poverty and overcrowding. |
| Barbosa et al. (2021) [62] | Disparities in alcohol consumption | Cross-sectional study | Online survey of US adults (≥21 years old) (N = 993) in February 2020 and April 2020. | Compared to February 2020, in April 2020, average drinks per day was 29% higher, risky drinking was 20% higher, and binge drinking was 21% higher. The increases were larger for women than men, and Black patients. |
| Damjanovska et al. (2021) [61] | Disparities in ALD | Retrospective cohort study | Claims data from the US (N = 8445,720) | Prevalence of AH treatment more than doubled from pre-covid to during the COVID era. Black patients were more likely to be diagnosed with AH (OR 2.63) or alcohol-associated pancreatitis (OR 2.17). |
| Deutsch-Link et al. (2022) [27] | ALD mortality | Cross-sectional study | United States mortality data from the National Center for Health Statistics | From 2019–2020, the highest relative increase in ALD mortality was observed in American Indian/Alaska Native and Asian men, and American/Indian Alaska Native and Hispanic/Latina women. Women had a higher relative increase (27%) than men (21%). |
| Devoto et al. (2022) [65] | Mental health and alcohol consumption | Prospective cohort study | US online survey of adult women as part of a larger longitudinal study (N = 499) | 30% of women reported worsening intimate partner violence, and 17% of women reported using drugs or alcohol to cope with relationship problems after the onset of the pandemic. Risky alcohol consumption was associated with anxiety and depression. |
| Lee et al. (2021) [7] | Alcohol sales | Nielsen National Consumer Panel prospective cohort study | Households in the contiguous United States (N = 144,704 households) | Asian (55%), Black (42%) and Hispanic/Latinx (40%) individuals had a higher relative increase in alcohol purchases from 2019 to 2020 compare to White people (34%) or Other (25%); the absolute increase was highest in White individuals. |
| Rodriguez et al. (2020) [4] | Alcohol consumption | Cross-sectional survey | Adults living in the United States (N = 754) | Psychological distress from COVID-19 was associated with higher alcohol consumption in women, but not men. |
| Sohal et al. (2022) [25] | AH hospitalizations | Retrospective cohort | Hospitalizations for AH at 2 community hospitals in California (N = 329) | Between 2019 and 2020, relative AH admissions increased more in female patients (125%) than male patients (35%). Higher increases were seen in those < 40 years (100%), than 40–60 years (28%). |
| Improving Care Delivery and the Incorporation of Telemedicine | ||||
| Bossi et al. (2020) [71] | Web-based program for group treatment of ALD | Intervention/Case-series. 10 patients enrolled into 3 weeks of web-based group treatment. | Ten adult ALD patients included starting in March 2020 | Adherence was high (7/10 patients attended over 90% of group meetings). 2/10 dropped out, and 2/10 experience a relapse. |
| Kaner et al. (2017) [70] | Digital interventions for AUD | Cochrane Review | 57 studies included with 34,390 participants | No difference in outcomes comparing digital and face-to-face interventions. Majority of studies demonstrated some reduction in binge-drinking (moderate-quality evidence), with an average reduction of 3 standard drinks per week. |
| Kruse et al. (2020) [69] | Telemedicine for AUD | Systematic review | Systematic review of 22 studies examining the impact of telemedicine on treatment of AUD | 16 studies (73%) reported a statistically significant reduction in alcohol consumption. |
| Yau et al. (2021) [72] | Multidisciplinary virtual clinic for patients with AUD and ALD | Experimental cohort study | Adults ≥ 18 years of age with ALD at receiving care through a multidisciplinary virtual clinic for AUD and ALD in Canada (N = 61) | Clinic retention rate was 75%. 70% of patients were started on anti-craving medications and 45% of patients remained abstinent from alcohol during the study period. |
| Response to Rising Alcohol Consumption and Burden of Alcohol-Associated Liver Disease | ||||
| Aslam et al. (2021) | Impact of alcohol taxes on waitlisting for liver transplantation | Retrospective Cohort Study | UNOS adult liver transplant waitlist additions for ALD from 2007 to 2016 (N = 24,316) | Associated between lower beer tax and higher ALD transplant waitlisting. |
| Bush et al. (1998) [81] | Evaluation of AUDIT and AUDIT-C screening tools | Cross-sectional study | Veterans Affairs patients from 3 general medicine clinics were administered with AUDIT and AUDIT-C (N = 243) | AUDIT-C outperformed full AUDIT for detecting heavy drinking. A cutoff of ≥3 had a sensitivity of 98% and specificity of 57%, and ≥4 had a sensitivity of 91% and specificity of 70% for heavy drinking. |
| Elder et al. (2010) [84] | Impact of tax policies on alcohol consumption and related harms | Systematic Review | 72 papers and technical reports included | Nearly all studies found an inverse relationship between tax/price of alcohol on heavy alcohol use and harmful alcohol-related outcomes. |
| O'Donnell et al. (2014) [99] | Brief alcohol interventions in primary care | Systematic review of reviews | 24 systematic reviews included | Brief alcohol interventions were consistently effective and reducing hazardous and harmful drinking in primary care. |
| Ponicki et al. (2006) [86] | Impact of alcohol taxes on cirrhosis mortality | Retrospective population-based study | 30 U.S. states from 1971 to 1998 (N = 840 state-by-year observations) | Cirrhosis mortality was significantly related to taxes on distilled spirits, but not to taxation of wine and beer. |
| Rogal et al. (2020) [90] | Impact of AUD treatment of ALD outcomes | Retrospective cohort study | Adults receiving care in the VA health system with cirrhosis and AUD (N = 35,682) | 12% of patients received behavioral treatment alone, 1% received pharmacotherapy and behavior treatment, and 0.4% received pharmacotherapy alone. Treated was associated with lower risk of hepatic decompensation and lower short and long-term mortality. |
| Rush et al. (1986) [85] | Impact of alcohol tax policy on alcohol consumption mortality from cirrhosis | Retrospective population-based study | Alcohol sales data and state-wide mortality data | In Michigan, from 1955 to 1982, the relative price of alcohol decreased by more than 50%, and per capita consumption and death due to cirrhosis increased substantially. |
| Vickers Smith et al. (2019) [83] | Trajectories associated with AUDIT-C scores | Prospective cohort study | Million Veteran Program cohort who were administered the AUDIT-C (N = 495,178) | Successful implementation of AUDIT-C for yearly alcohol use screening. Higher-risk AUDIT-C score groups were associated with increased prevalence of AUD, cirrhosis and hepatitis C. |
| Watkins et al. (2017) [101] | Collaborative care models in primary care for treatment of AUD and opioid use disorder | Randomized clinical trial | 377 primary care patients in 2 federally qualified health centers in the US. | Patients randomized to collaborative care model were more likely to receive treatment for their AUD, report abstinence and higher engagement. |
AC; alcohol-associated cirrhosis. ACLF; acute-on-chronic liver failure. AH; alcohol-associated hepatitis. ALD; alcohol-associated liver disease. AOR; adjusted odds ratio. AUD; alcohol use disorder. AUDIT-C; Alcohol Use disorders Identification test – Consumption. CLD; chronic liver disease. CP; Childs-Pugh. EHR; electronic health record. ICU; intensive care unit. OR; odds ratio. SUD; substance use disorder.