UNC’s Sasha Deutsch-Link, MD, a fellow in the Department of Gastroenterology and Hepatology, is the lead author of a study indicating that alcohol-associated liver disease (ALD) increased from 2017-2020 and accelerated during the COVID-19 pandemic in almost all age groups. Andrew Moon, MD, MPH, is a senior author.
A study published in Journal of Clinical Gastroenterology and Hepatologyand led by UNC School of Medicine researchers, found that mortality from alcohol-associated liver disease (ALD) accelerated during the COVID-19 pandemic.
“We have actually seen for some time now that the mortality rate of alcohol-associated liver disease has increased in the United States,” said Sasha Deutsch-link, MD, study leader and fellow in the UNC Division of Gastroenterology and Hepatology at the UNC Institute of Medicine. “This trend dates back to 2006, and we have seen a steady increase in overtime. In our paper, we really wanted to update these trends to see if we saw this continued increase. “
The study’s senior author is Andrew Moon, MD, MPH, and co-authors are A. Sidney Barritt IV, MD, MSCR, and Anne Peery, MD, MSCR, all from the UNC Division of Gastroenterology and Hepatology.
Formerly The American Journal of Gastroenterology reported that ALD mortality increased between 2006 and 2017. Since 2017, alcohol consumption has continued to increase. To update trends in ALD-related mortality in the United States and to quantify the rate of change, researchers extracted data from January 1, 2017 to December 31, 2020, using the underlying cause of death for public use from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics. Researchers studied age-adjusted mortality rates aged 25 years and older in all U.S. residents, and it was stratified by gender, age, and race / ethnicity to update previously published data.
The UNC team found that from 2017 to 2020, there was a continued increase in ALD-related mortality. The average annual percentage change in deaths increased by about 9% per year for men and about 12% per year for women. Researchers also saw how the changes in ALD deaths increased markedly in early 2020 for both men and women. The annual percentage change in the increase from 2019 to 2020 in men was 21% overall and in women 27%. In women aged 25-34 there was an increase of 38% and in the age group 35-44 there was an increase of 47%. For men aged 25-34 years, the researchers saw an increase of 51%, and for men aged 35-44 years, it was an increase of 45%.
From interruptions in work and school to shifts in alcohol consumption in bars and restaurants to home use, alcohol consumption continued to rise aggressively, especially during the pandemic. From 2017 to 2020 and 2019 to 2020, the group with the highest relative increase in ALD was younger adults aged 25-44. The demographic with the highest overall ALD mortality is in the older age group aged 45-64.
“We knew that deaths from liver disease from alcohol were increasing before COVID-19, and this study confirmed our suspicion that these regarding increases in ALD deaths were irritated by the COVID-19 pandemic,” Moon said.
Trends in mortality rates for ALD from 2017 to 2020 in terms of age, race, and ethnicity show that annual increases in deaths were seen in all age groups except those over 85 years of age. The highest age-adjusted rates were found among Native American / Alaska Native, Hispanic, and white individuals. Asian men had the highest relative increase in ALD-related mortality, probably due to a low baseline ALD mortality. The analysis also indicates that some increases in ALD mortality, both in rate and absolute number, were seen before the pandemic. An underlying explanation for these trends is the increase in alcohol consumption and alcohol-related complications before and during the pandemic.
“Previous research has shown that rising unemployment and economic insecurity can exacerbate dependency at the societal level,” Deutsch-link said. “Seeking isolation and quarantine loneliness may also have exacerbated alcohol consumption and alcohol abuse. In patients with underlying liver disease, increased alcohol consumption or worsening of the severity of an alcohol abuse can lead to increased mortality,” she said.
Other potential contributors include increasing obesity / metabolic syndrome and comorbid non-alcoholic fatty liver disease, which may increase the risk of developing ALD. The pandemic may also have compromised appropriate health care for patients with ALD, especially those who were concerned about seeking care in a hospital.
“Many patients with alcohol abuse, especially early in the pandemic, had a harder time engaging in alcohol counseling, especially in group settings like Alcoholics Anonymous,” Moon said. “Patients with acute alcohol-related hepatitis probably delayed entering the hospital until they were very ill. That means patients were likely to come in at a time when their alcohol-associated hepatitis was life-threatening and there may be less to offer from a medical standpoint. “
The analysis shows how ALD mortality is increasing among men and women of almost all ages and racial / ethnic demographic groups in the United States, a worrying trend that may cause a sustained increase in ALD mortality.
“I would not be surprised if many of the deaths we see in the last few years are from alcohol-associated hepatitis, and maybe in 10 to 15 years from now, we will also see an increase in alcohol-associated cirrhosis of liver and liver cancer among these patients, ”said Moon.
The urgent need to reduce the increasing ALD disease burden and mortality requires a nationwide effort to reduce national alcohol consumption, improve the screening of alcohol consumption disorders, and optimize early treatment.
“We need to increase access to evidence-based treatment for alcohol abuse,” Deutsch-link said. “There is a shortage of drug treatment providers in our country. There are policies at government level that could potentially affect alcohol consumption. I think we can take some experience from the opioid crisis, where this became a national crisis, and the response involved political change and “funding programs that really address these issues. We need to learn from these interventions to see what we can do now to specifically address alcohol consumption disorders.”
Dr. Deutsch-link’s research was supported in part by a grant from the National Institutes of Health – T32 DK007634. Dr. Moon was supported by an Advanced / Transplant Hepatology Award (AASLD Foundation).
Media contact: Brittany PhillipsUNC School of Medicine, 919-270-6212