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Comment on: Impact of the COVID-19 pandemic on liver disease-related mortality rates in the United States

Published:November 29, 2022DOI:https://doi.org/10.1016/j.jhep.2022.11.018

      Linked Article

      To the editor:
      We read with great interest the article by Gao et al.
      • Gao X.
      • Lv F.
      • He X.
      • Zhao Y.
      • Liu Y.
      • et al.
      Impact of the COVID-19 pandemic on liver disease-related mortality rates in the United States.
      , who used a national death dataset to determine the impact of the COVID-19 pandemic on people with liver disease in the USA. Finally, they found that age-standardised mortality rates for alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) increased at an alarming rate during the COVID-19 pandemic. Hospitalization for ALD is also on the rise during the COVID-19 pandemic due to increased alcohol consumption. We conducted a relevant analysis in support of this view to confirm it (Fig. 1).
      Previous studies reported an increase in alcohol abuse in 2020 due to increased economic insecurity, unemployment, and psychological distress in the COVID-19 pandemic
      • Deutsch-Link S.
      • Curtis B.
      • Singal A.K.
      Covid-19 and alcohol associated liver disease.
      . In the first year of the pandemic, alcohol sales in the United States increased significantly, from $7.1 billion in 2019 to $9.5 billion in 2020
      • Deutsch-Link S.
      • Curtis B.
      • Singal A.K.
      Covid-19 and alcohol associated liver disease.
      . With the increase in alcohol sales, recent studies have also identified an increase in hospitalization for ALD
      • Sohal A.
      • Khalid S.
      • Green V.
      • Gulati A.
      • Roytman M.
      The Pandemic Within the Pandemic: Unprecedented Rise in Alcohol-related Hepatitis During the COVID-19 Pandemic.
      • Gonzalez H.C.
      • Zhou Y.
      • Nimri F.M.
      • Rupp L.B.
      • Trudeau S.
      • Gordon S.C.
      Alcohol-related hepatitis admissions increased 50% in the first months of the COVID-19 pandemic in the USA.
      • Shaheen A.A.
      • Kong K.
      • Ma C.
      • Doktorchik C.
      • Coffin C.S.
      • Swain M.G.
      • et al.
      Impact of the COVID-19 Pandemic on Hospitalizations for Alcoholic Hepatitis or Cirrhosis in Alberta, Canada.
      . Therefore, we conducted a meta-analysis and aimed to assess the admission growth rate of ALD. Using the pre-designed search strategy, we identified the relevant studies that compared the admission rate of ALD between before and during the COVID-19 pandemic in Embase, Cochrane, and PubMed databases from inception to October 2022. The primary outcome was the pooled admission growth rate of ALD. Finally, a total of three studies were included
      • Sohal A.
      • Khalid S.
      • Green V.
      • Gulati A.
      • Roytman M.
      The Pandemic Within the Pandemic: Unprecedented Rise in Alcohol-related Hepatitis During the COVID-19 Pandemic.
      • Gonzalez H.C.
      • Zhou Y.
      • Nimri F.M.
      • Rupp L.B.
      • Trudeau S.
      • Gordon S.C.
      Alcohol-related hepatitis admissions increased 50% in the first months of the COVID-19 pandemic in the USA.
      • Shaheen A.A.
      • Kong K.
      • Ma C.
      • Doktorchik C.
      • Coffin C.S.
      • Swain M.G.
      • et al.
      Impact of the COVID-19 Pandemic on Hospitalizations for Alcoholic Hepatitis or Cirrhosis in Alberta, Canada.
      . Overall, the pooled admission growth rate of ALD was 43.6% (95% CI, 27.3% to 61.4%; I2 = 94.139%). We observed a significant increase in the number of ALD admissions during the COVID-19 pandemic compared with previous years.
      The COVID-19 pandemic is having a significant impact on the health status of people with ALD. Increased alcohol consumption has the potential to exacerbate the condition in patients with liver impairment, leading to increased admission rates for ALD. Alcohol consumption is a major contributor to acute-on-chronic liver failure, a common syndrome in patients with underlying cirrhosis characterized by acute decompensation of the liver cirrhosis, organ failure, and high short-term mortality. So the increased alcohol consumption during the COVID-19 pandemic is bound to bring increased rate of hospitalization, decompensation of cirrhosis, and mortality.

      Conflict of interest statement

      Han Zhang, Yan Peng, and Xiaowei Tang declare that they have no conflict of interest.

      Author contributions

      Study conception and design: Xiaowei Tang; acquisition of data: Han Zhang; drafting of manuscript: Han Zhang; revision of manuscript: Yan Peng; and final approval of manuscript: Xiaowei Tang.

      Financial support

      This study is independent research funded by no grants.

      References

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        • Lv F.
        • He X.
        • Zhao Y.
        • Liu Y.
        • et al.
        Impact of the COVID-19 pandemic on liver disease-related mortality rates in the United States.
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        • Deutsch-Link S.
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        • Sohal A.
        • Khalid S.
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        The Pandemic Within the Pandemic: Unprecedented Rise in Alcohol-related Hepatitis During the COVID-19 Pandemic.
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        • Gonzalez H.C.
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        Alcohol-related hepatitis admissions increased 50% in the first months of the COVID-19 pandemic in the USA.
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        • Shaheen A.A.
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        • Doktorchik C.
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        Impact of the COVID-19 Pandemic on Hospitalizations for Alcoholic Hepatitis or Cirrhosis in Alberta, Canada.
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