Alcohol’s Role in Liver Disease Deaths During COVID-19

While it is well-known that alcohol is linked to liver disease mortality, new research shows the mortality impacts of increased alcohol use during the COVID-19 pandemic.

The overall number of deaths involving alcohol spiked 25.5% to 99,017 between 2019 and 2020, according to a research letter published in JAMA.

Alcohol-related deaths accounted for 2.8% of all deaths in 2019 and 3% in 2020, and the uptick in alcohol-related deaths in 2020 outpaced the increase in all-cause mortality of 16.6%.

Notably, the number of deaths with an underlying cause of alcohol-associated liver diseases jumped 22.4% to 29,504 from 2019 to 2020.

While the Centers for Disease Control’s mortality records do not explain the reasons behind the increase in liver disease deaths, there are several possibilities that remain speculative, Aaron White, Ph.D., one of the authors of the research letter and chief of the Epidemiology and Biometry Branch at National Institute on Alcohol Abuse and Alcoholism (NIAAA), told Managed Healthcare Executive®.

“We know from more than a dozen survey studies that many people increased their alcohol consumption during the pandemic in an effort to cope with pandemic-related stress. For people with existing liver disease, the increases in consumption could have been sufficient to cause liver failure and death,” White said.

Deaths involving alcohol “reflect hidden tolls of the pandemic,” White wrote. “Increased drinking to cope with pandemic-related stressors, shifting alcohol policies, and disrupted treatment access are all possible contributing factors.”

Whether alcohol-related deaths will decline as the pandemic wanes, and whether policy changes could help reduce such deaths, warrants consideration, White noted.

Prior to the pandemic, there were already increases in alcohol consumption and related harms, such as emergency department visits, cases of cirrhosis, and deaths, White said. However, the pandemic “seems to have exacerbated these trends.”

In fact, the increase in alcohol consumption during the pandemic is expected to result in 8,000 additional deaths from alcohol-related liver disease, according to a study published in Hepatology.

Senior author Jagpreet Chhatwal, Ph.D., associate director of Massachusetts General Hospital’s Institute for Technology Assessment and an assistant professor of radiology at Harvard Medical School, and colleagues found that excessive drinking (such as binge drinking) increased by 21% during the COVID-19 pandemic.

The researchers then simulated the drinking trajectories and liver disease trends in all U.S. adults. They estimated that a one-year increase in alcohol consumption during the pandemic will result in 8,000 additional deaths from alcohol-related liver disease, 18,700 cases of liver failure, and 1,000 cases of liver cancer by 2040.

Plus, in the short term, they expect alcohol consumption changes due to COVID-19 to cause 100 additional deaths and 2,800 additional cases of liver failure by 2023.

The researchers noted that a sustained increase in alcohol consumption for more than one year could result in 19 to 35% additional mortality.

“Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high-risk alcohol drinking during the COVID-19 pandemic in the U.S.,” said senior author Chhatwal in a news release about the study.

Healthcare providers can also play a role in turning the trend around, according to White.

"Most Americans see a physician or other healthcare provider each year. We believe each of these visits is an opportunity for providers to ask patients a view simple questions about their alcohol use and offer advice to cut down and connect patients to further resources, if warranted,” he said.