WASHINGTON—Gastroenterologists and hepatologists still are seeing the effects of the COVID-19 pandemic, which has manifested in increased mortality rates for alcohol-associated liver disease and nonalcoholic fatty liver disease among younger people and some ethnic minority groups, as well as a significant, sustained increase in hospital admissions for alcohol-related hepatitis, according to two studies presented at The Liver Meeting 2022.

In the first study, researchers at Stanford University and Cedars-Sinai Medical Center in California, and Xi’an Jiaotong University, in China, examined trends in liver disease mortality and age and racial/ethnic disparities before and during the pandemic. The team used data from the CDC’s WONDER database of the National Vital Statistics System to estimate age-standardized mortality rates (ASMR) of liver disease between 2010 and 2021, reported investigator Yee Hui Yeo, MD, MSc, of Stanford University. They used death certificate data on age, sex, racial/ethnic groups and causes of death, Dr. Yeo said.

Liver-Related Mortality Increases

During the overall study period, approximately 340,000 patients died from alcohol-associated liver disease (ALD), 200,000 from hepatitis C infection, 58,000 due to NAFLD and 20,000 due to hepatitis B, Dr. Yeo said. The annual percentage change in death increased 3.5% for 2010 to 2019 and 17.6% for 2020 to 2021.

Although hepatitis C–related deaths had declined significantly between 2014 and 2019, after the establishment of curative treatment, that decrease “became a non-significant change” during the pandemic, he said, noting that this was a sign of halted progress.

Mortality rates for ALD and NAFLD had “a significant surge” during the pandemic, with annual percentage increases of approximately 17.6% for ALD and 14.5% for NAFLD, according to the investigators.

The ASMR rise for ALD during the study period was “particularly severe” among people aged 25 to 44 years, at 34.6%—almost triple that of people aged 45 to 64 (13.7%) and 65 years and older (12.6%). For NAFLD, the ASMR rate among those aged 25 to 44 years was almost double that of older age groups—28% compared with 7.4% for those aged 45 to 64 years and 12% for those 65 years and older, Dr. Yeo said.

Between 2010 and 2019, the ASMR rise for ALD-related mortality was most pronounced in non-Hispanic whites (11.7%), Blacks (10.8%) and American Indians/Alaska Natives (18%), while during the pandemic, the sharpest increases were seen among non-Hispanic whites and non-Hispanic Blacks (annual percentage change, 11.9%), non-Hispanic Asians (12.9%), Hispanics (13.1%), and American Indians/Alaska Natives (10.9%). For NAFLD, there were no significant differences among the racial and ethnic groups, Dr. Yeo said.

ALD Hospitalizations On the Rise

In the second study, researchers at UCSF Fresno evaluated whether a significant increase in alcohol-related hepatitis requiring hospitalization observed early on in the pandemic (J Clin Gastroenterol 2022 1;56[3]:e171-e175) was still ongoing later in the pandemic or had subsided.

In a retrospective chart review of 547 patients presenting with alcohol-related hepatitis in three community hospitals in Fresno between 2019 (pre-pandemic) and 2021, they found that the overall number of cases increased from 131 in 2019 to 201 in 2020 and 215 in 2021, increases of 53% and 64%, respectively.

A more disturbing trend was noted among women and patients under 40 years of age, said investigator Aalam Sohal, MBBS, a hepatology fellow at the Liver Institute Northwest, in Seattle, who worked on the project while a resident at UCSF Fresno. In women, the number of admissions increased from 24 in 2019 to 67 in 2021, which was a 179% increase in the total number of cases, Dr. Sohal said. Among patients under age 40, the number of cases increased from 30 in 2019 to 71 in 2021, a 136% jump.

He and his co-investigators also observed a 4.5-fold increase in readmissions related to the condition, from 18 in 2019 to 80 in 2021.

These trends in ALD “might be reflective of a larger national problem, and further studies are needed at a national level to assess the overall burden of this disease,” Dr. Sohal said. “We believe that urgent public health interventions are needed at the community, state and national level in order to curb this disease.”

—Karen Blum

The presenters reported no relevant financial disclosures.