Alcohol-Associated Hepatitis Hospitalizations Increased During COVID-19

Credit: Ante Samarzija

Annual hospitalizations due to alcohol-associated hepatitis increased by more than 20,000 patients in the US during the COVID-19 pandemic, according to new analysis.¹

In analysis of National Inpatient Sample (NIS) data from 2019 – 2020, a team of US-based investigators reported that despite an approximate 9% decline in national hospital admissions in the first year of the COVID-19 pandemic, hospitalizations due to alcohol-associated hepatitis actually increased by approximately 16%. The findings correlate with observed trends of increased excessive alcohol use in the US during the pandemic—as well as hospitalizations due to alcohol-associated hepatitis itself, which has been occurring for more than a decade.

The data also contribute to the understood prevalence of alcohol-associated hepatitis in the US, which was recently reported to have increased by more than 70% among high-risk populations including those in lower socioeconomic status in just 4 years.²

Led by Natalie Marlowe of the Durect Corporation, investigators sought to analyze available NIS data to interpret measures of mortality and health care utilization among hospitalized patients with alcohol-associated hepatitis, with and without COVID-19, from 2020.

“COVID-19 pandemic has led to anxiety, psychological stress, and tension,” investigators wrote. “Alcohol consumption is a common coping mechanism for psychological distress as confirmed by a significant increase of alcoholic beverages sales during the peak of the pandemic in the US. Little is known about the impact of COVID-19 infection among hospitalized alcohol-associated hepatitis patients.”

The team used NIS data for inpatient care records from 2015 – 2020, with analysis of COVID-19 cases among hospitalized patients with alcohol-associated hepatitis derived from 2020 data. Diseases were defined by ICD-9 and ICD-19 codes. They estimated linear trends against independent national estimates of disease burden and health care utilization.

Total hospitalization cases decreased from approximately 35.8 million in 2015 to 35.4 million in 2019, and again to 32.4 million in 2020—an 8.7% decline from 2019 – 2020.

Total hospitalization cases for alcohol-associated hepatitis totaled 110,135 (0.31% of all hospitalizations) in 2015, increasing to 136,620 (0.39%) in 2019. The total increased significantly in 2020, to 157,885 (0.49%; P <.0001)—a 15.6% increase from 2019 – 2020. Comparatively, the average annual growth of alcohol-associated hepatitis hospitalizations was 5.5% from 2015 – 2019.

Marlowe and colleagues observed 2900 (1.83%) cases of COVID-19 among hospitalized alcohol-associated patients in 2020. Such patients were generally younger (46.4 vs 47.3 years; P <.0001), experienced a longer length of hospital stay (8.6 vs 6.1 days; P <.0001), and reported a nearly 3-fold greater mortality rate (11.4% vs 4.1%; P <.0001). Patients with COVID-19 and alcohol-associated hepatitis reported nearly 50% greater average hospital charges ($93,670 vs $66,283; P <.0001).

Patients with who died with alcohol-associated hepatitis and COVID-19 in the hospital additionally reported significantly greater incidence of cirrhosis, acute renal failure, upper gastrointestinal bleeding, and sepsis.

“In contrast to total admissions in the US, we found a significant increase in total hospitalized alcohol-associated hepatitis cases, with an incremental increase approximately 3 times higher than the previous year,” investigators wrote. “While we do not have information on the pattern and quality of alcohol consumption among these hospitalized AH patients, it is plausible that this clinical observation is secondary to increased alcohol consumption during the pandemic.”

The team concluded that screening and more appropriate management of excessive alcohol use, combined with adherence to recommended COVID-19 vaccination and other preventive measures, could help to limit the increased rate of morbidity and mortality of hospitalized patients.

References

1. ^{Marlowe N, Lam D, Liangpunsakul S. Epidemic within pandemic: Alcohol-associated hepatitis and COVID-19 [published online ahead of print, 2023 Aug 8]. Alcohol (Hoboken). 2023;10.1111/acer.15162. doi:10.1111/acer.15162}
2. ^{Kunzmann K. Alcohol-Associated Hepatitis Rapidly Increasing in the US. HCPLive. Published July 18, 2023. https://www.hcplive.com/view/alcohol-associated-hepatitis-rapidly-increasing-us}