Alcohol Misuse During COVID-19 Associated with Increase in Alcoholic Hepatitis

Jessica L. Mellinger, MD

Although a significant increase in alcohol consumption during the COVID-19 pandemic has been observed, there are still unknowns regarding its impact on rising rates of alcohol-associated liver disease (ALD).

Led by Jessica L. Mellinger, MD, Division of Gastroenterology and Hepatology, University of Michigan, a team of investigators hypothesized a disproportionate rise in waiting list registrations and deceased donor liver transplants (DDLTs) for alcoholic hepatitis.

Accordingly, findings from the study show waiting list registrations and DDLTs for alcoholic hepatitis increased significantly during the COVID-19 pandemic period, surmounting volumes forecasted by pre-COVID-19 trends by more than 50%.

What were the methods?

The methodology for the cross-sectional study started with an examination into national changes in waiting list registration and liver transplantation for ALD, as well as the association with alcohol sales during the pandemic.

In doing so, data were obtained from the United Network for Organ Sharing Standard Transplant Analysis and Research for new waiting list registration and primary DDLT for adults in the US aged ≥18 years between January 2016 - January 2021. Each was categorized by primary listing diagnosis as alcoholic hepatitis, alcohol-related cirrhosis, or non-ALD.

Short-term changes during the COVID-19 period, considered March 2020 - January 2021, were identified through a comparison of proportions of waiting list registrations and DDLT to the pre-COVID-19 period (March 2019 - January 2020) using χ2 tests.

Then, in evaluating changes during the pandemic to long-term trends, a comparison of monthly volumes of waiting list registrations and DDLTs from the COVID-19 period to forecasted values based on pre-COVID-19 trends.

Further, investigators collected data on national monthly retail alcohol sales from the US Census Bureau Monthly Retail Trade report between January 2016 - January 2021. They were evaluated using Spearman rank-order correlation, with a significance level of .05.

What were the findings?

Overall, investigators assessed 51,488 new waiting list registrations and 32,320 DDLTs during the study period. Of that population, the median age was 58.0 years for both pre-COVID-19 waiting list registrants and liver transplant recipients, as well as new waiting list registrants and transplant recipients during COVID-19.

In new waiting list registrant demographics, 15 247 (36.1%) were women and 26 930 (63.9%) were men during the pre-COVID-19 period, while 3477 (37.3%) were women and 5834 (62.7%) were men during COVID-19 (P = .03).

A significant increase in the proportions of waiting list registrations (227 of 9311, 2.4%) was observed in comparison to the pre-COVID-19 period (138 of 9638 registrations [1.4%]; P < .001) for alcoholic hepatitis.

Similarly, a significant increase was seen in the proportions of DDLTs in the COVID-19 period (185 of 6162, 3.0%) compared to the pre-COVID period (103 of 6263, 1.6%; P < .001).

An overall reduction was observed in waiting list registration and DDLT at the start of COVID-19 when looking at long-term pre-COVID-19 trends. Mellinger and colleagues saw volumes of waiting list registrations and DDLTs for alcoholic hepatitis exceeded expected trends by a mean of 59.5% in waiting list registrations and 62.0% in DDLTs.

Additionally, the group observed a temporal association and positive correlation between increased waiting list registrations (Spearman ρ = 0.79; P < .001) and DDLT for alcoholic hepatitis (Spearman ρ = 0.76; P < .001) and increasing retail sales of alcohol.

Takeaways

“While we cannot confirm causality, this disproportionate increase in association with increasing alcohol sales may indicate a relationship with known increases in alcohol misuse during COVID-19,” investigators wrote.

The study, “Association of COVID-19 With New Waiting List Registrations and Liver Transplantation for Alcoholic Hepatitis in the United States,” was published in JAMA Network Open.