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. 2022 Jun;75(6):1480-1490.
doi: 10.1002/hep.32272. Epub 2022 Jan 24.

Effect of increased alcohol consumption during COVID-19 pandemic on alcohol-associated liver disease: A modeling study

Jovan Julien  1   2 , Turgay Ayer  1 , Elliot B Tapper  3 , Carolina Barbosa  4 , William N Dowd  4 , Jagpreet Chhatwal  2   5   6
Affiliations

Effect of increased alcohol consumption during COVID-19 pandemic on alcohol-associated liver disease: A modeling study

Jovan Julien et al. Hepatology. 2022 Jun.

Abstract

Background and aims: Alcohol consumption increased during the COVID-19 pandemic in 2020 in the United States. We projected the effect of increased alcohol consumption on alcohol-associated liver disease (ALD) and mortality.

Approach and results: We extended a previously validated microsimulation model that estimated the short- and long-term effect of increased drinking during the COVID-19 pandemic in individuals in the United States born between 1920 and 2012. We modeled short- and long-term outcomes of current drinking patterns during COVID-19 (status quo) using survey data of changes in alcohol consumption in a nationally representative sample between February and November 2020. We compared these outcomes with a counterfactual scenario wherein no COVID-19 occurs and drinking patterns do not change. One-year increase in alcohol consumption during the COVID-19 pandemic is estimated to result in 8000 (95% uncertainty interval [UI], 7500-8600) additional ALD-related deaths, 18,700 (95% UI, 17,600-19,900) cases of decompensated cirrhosis, and 1000 (95% UI, 1000-1100) cases of HCC, and 8.9 million disability-adjusted life years between 2020 and 2040. Between 2020 and 2023, alcohol consumption changes due to COVID-19 will lead to 100 (100-200) additional deaths and 2800 (2700-2900) additional decompensated cirrhosis cases. A sustained increase in alcohol consumption for more than 1 year could result in additional morbidity and mortality.

Conclusions: A short-term increase in alcohol consumption during the COVID-19 pandemic can substantially increase long-term ALD-related morbidity and mortality. Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high-risk alcohol drinking in the United States.

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Conflict of interest statement

Elliot Tapper has served as a consultant to Norvartis, Axcella, Kaleido, and Allergan; served on advisory boards for Takeda, Mallinckrodt, Rebiotix, and Bausch Health; and received unrestricted research grants from Gilead and Valeant. Jagpreet Chhatwal has served as a consultant to Novo Nordisk and partner at Value Analytics Labs. Turgay Ayer has served as a consultant to Merck and partner at Value Analytics Labs. No other author has a conflict of interest.

Figures

FIGURE 1
FIGURE 1
State‐transition model of the natural history of ALD and drinking state. A patient is represented by the combination of one of the health states and one drinking state, shown here as rectangles and circles. Arrows between states represent annual transition probabilities, with the blue shaded states representing decompensated cirrhosis. Competing‐cause mortality, the probability of dying from other causes both related and unrelated to alcohol use, exists in every state but is not shown in our diagram for simplicity. F0, F1, and F2 represent no fibrosis (F0), mild fibrosis (F1), and moderate fibrosis (F2). F3 indicates septal fibrosis, F4 represents compensated fibrosis, and the darker blue stages represent various complications of decompensated fibrosis. The lighter shade of blue encompasses all the cirrhotic disease states. “HCC” indicates a patient has HCC, and mortality from stages F4 on contribute to the reported liver‐related mortality. The health states H1–H5 are tunnel states representing healthy liver predrinking states. These states are calibrated to reproduce the distribution of the age at first drink for the US population, as evidenced in the NESARC‐III
FIGURE 2
FIGURE 2
Birth cohort ALD disease mortality 2012–2018 with CDC mortality validation. Mortality is as reported in the US National Death Registry and predicted/projected mortality in our model from the start of the calibration period through the end of the validation period. Shaded regions represent the UIs generated by probabilistic sensitivity analysis. (A) Adults born between 1920 and 1939; (B) adults born between 1940 and 1959, (C) adults born between 1960 and 1979, and (D) adults born between 1980 and 1999
FIGURE 3
FIGURE 3
Difference in alcohol‐related liver mortality and morbidity between COVID‐19 consumption scenario and counterfactual for US adults aged 18+, 2019–2040. Annual and cumulative rates for morbidity and mortality differences between the COVID‐19 consumption scenario and counterfactual scenario associated with ALD. In the COVID‐19 consumption scenario, some drinkers increase consumption during 2020, while in the counterfactual scenario, drinking progresses without any increases associated with COVID‐19. Shaded regions represent the 95% UI associated with the probabilistic sensitivity analysis
FIGURE 4
FIGURE 4
Sensitivity analysis projecting difference in alcohol‐related liver mortality and morbidity between a counterfactual scenario and COVID‐19 consumption scenario under varying duration of alcohol consumption in adults aged 18+. Annual and cumulative mortality differences between the counterfacture scenario and COVID‐19 scenario with sustained increase in alcohol consumption for 1, 3, and 5 years. In the base COVID‐19 consumption scenario some drinkers increase consumption during the 2020 based on a survey of changes in the US population. Consumption is increased for 1, 3, or 5 years and compared with a counterfactual drinking scenario that progresses without any increases associated with COVID‐19. Shaded regions represent the 95% UI associated with the probabilistic sensitivity analysis
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References

    1. Barbosa C, Cowell AJ, Dowd WN. Alcohol consumption in response to the COVID‐19 pandemic in the United States. J Addiction Med. 2021;15(4):341‐4. - PMC - PubMed
    1. Pollard MS, Tucker JS, Green HD. Changes in adult alcohol use and consequences during the COVID‐19 pandemic in the US. JAMA Network Open. 2020;3:e2022942. - PMC - PubMed
    1. Barbosa C, Karriker‐Jaffe K, Dowd W. One year later: how have american drinking habits changed during the COVID‐19 pandemic. RTI International; 2021. https://www.rti.org/sites/default/files/fy21_covid_drinking_webinar_slid.... Accessed 30 Aug 2021.
    1. IZEA . Coronavirus impacts on alcohol & social media consumption. IZEA; 2020.
    1. Drizly . How alcohol ecommerce sales are being impacted across North America. April 27, 2020; 2021. https://drizly.com/article/education/extras/how‐alcohol‐ecommerce‐sales‐.... Accessed 27 Apr 2020.

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