To the Editor:
We read with great interest the article by Gao et al.,1 who used a national death dataset to determine the impact of the COVID-19 pandemic on people with liver disease in the United States. They found that age-standardised mortality rates for alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) increased at an alarming rate during the COVID-19 pandemic. Hospitalization for ALD also increased during the COVID-19 pandemic due to increased alcohol consumption. We conducted a relevant analysis with the aim of confirming this observation.
Previous studies reported an increase in alcohol abuse in 2020 due to increased economic insecurity, unemployment, and psychological distress caused by the COVID-19 pandemic.2 In the first year of the pandemic, alcohol sales in the United States increased significantly, from $7.1 billion in 2019 to $9.5 billion in 2020.2 With the increase in alcohol sales, recent studies have also identified an increase in hospitalizations for ALD.[3], [4], [5] Therefore, we conducted a meta-analysis and aimed to assess the admission growth rate of ALD. Using a pre-designed search strategy, we identified the relevant studies that compared ALD admission rates before and during the COVID-19 pandemic in Embase, Cochrane, and PubMed databases from inception to October 2022. The primary outcome was the pooled admission growth rate of ALD. Three studies were included.[3], [4], [5] Overall, the pooled admission growth rate of ALD was 43.6% (95% CI 27.3–61.4%; I2 = 94.139%) (Fig. 1). We observed a significant increase in the number of ALD admissions during the COVID-19 pandemic compared with previous years.
Fig. 1.
Admission growth rate of alcohol-associated liver disease.
The COVID-19 pandemic is having a significant impact on the health status of people with ALD. Increased alcohol consumption has the potential to exacerbate liver impairment in patients with existing disease, leading to increased admission rates for ALD. Alcohol consumption is a major contributor to acute-on-chronic liver failure, a common syndrome in patients with underlying cirrhosis that is characterized by acute decompensation of cirrhosis, organ failure, and high short-term mortality. Hence, increased alcohol consumption during the COVID-19 pandemic is bound to increase rates of hospitalization, decompensation of cirrhosis, and mortality.
Financial support
This study is independent research funded by no grants.
Conflict of interest
Han Zhang, Yan Peng, and Xiaowei Tang declare that they have no conflict of interest.
Please refer to the accompanying ICMJE disclosure forms for further details.
Authors’ contributions
Study conception and design: Xiaowei Tang; acquisition of data: Han Zhang; drafting of manuscript: Han Zhang; revision of manuscript: Yan Peng; and final approval of manuscript: Xiaowei Tang.
Footnotes
Author names in bold designate shared co-first authorship.
Supplementary data to this article can be found online at https://doi.org/10.1016/j.jhep.2022.11.018.
Supplementary data
The following are the supplementary data to this article:
References
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