Background & Aims

The pandemic has resulted in an increase of deaths not directly related to COVID-19 infection. We aimed to use a national death dataset to determine the impact of the pandemic on people with liver disease in the USA, focusing on alcohol-associated liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD).

Methods

Using data from the National Vital Statistic System from the Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) platform and ICD-10 codes, we identified deaths associated with liver disease. We evaluated observed vs. predicted mortality for 2020–2021 based on trends from 2010–2019 with joinpoint and prediction modelling analysis.

Results

Among 626,090 chronic liver disease-related deaths between 2010 and 2021, Age-standardised mortality rates (ASMRs) for ALD dramatically increased between 2010–2019 and 2020–2021 (annual percentage change [APC] 3.5% to 17.6%, p <0.01), leading to a higher observed ASMR (per 100,000 persons) than predicted for 2020 (15.67 vs. 13.04) and 2021 (17.42 vs. 13.41). ASMR for NAFLD also increased during the pandemic (APC: 14.5%), whereas the rates for hepatitis B and C decreased. Notably, the ASMR rise for ALD was most pronounced in non-Hispanic Whites, Blacks, and Alaska Indians/Native Americans (APC: 11.7%, 10.8%, 18.0%, all p <0.05), with similar but less critical findings for NAFLD, whereas rates were steady for non-Hispanic Asians throughout 2010–2021 (APC: 4.9%). The ASMR rise for ALD was particularly severe for the 25–44 age group (APC: 34.6%, vs. 13.7% and 12.6% for 45–64 and ≥65, all p <0.01), which were also all higher than pre-COVID-19 rates (all p <0.01).

Conclusions

ASMRs for ALD and NAFLD increased at an alarming rate during the COVID-19 pandemic with the largest disparities among the young, non-Hispanic White, and Alaska Indian/Native American populations.

Impact and implications

The pandemic has led to an increase of deaths directly and indirectly related to SARS-CoV-2 infection. As shown in this study, age-standardised mortality rates for alcohol-associated liver disease and non-alcoholic fatty liver disease substantially increased during the COVID-19 pandemic in the USA and far exceeded expected levels predicted from past trends, especially among the young, non-Hispanic White, and Alaska Indian/Native American populations. However, much of this increase was not directly related to COVID-19. Therefore, for the ongoing pandemic as well as its recovery phase, adherence to regular monitoring and care for people with chronic liver disease should be prioritised and awareness should be raised among patients, care providers, healthcare systems, and public health policy makers.

中文翻译：

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COVID-19 大流行对美国肝病相关死亡率的影响

背景与目标

此次大流行导致与 COVID-19 感染没有直接关系的死亡人数增加。我们的目标是使用全国死亡数据集来确定这一流行病对美国肝病患者的影响，重点关注酒精相关性肝病 (ALD) 和非酒精性脂肪肝病 (NAFLD)。

方法

使用疾病控制和预防中心流行病学研究广泛在线数据 (CDC WONDER) 平台的国家生命统计系统的数据和 ICD-10 代码，我们确定了与肝病相关的死亡。我们根据 2010-2019 年的趋势，通过连接点和预测模型分析，评估了 2020-2021 年观察到的死亡率与预测的死亡率。

结果

2010年至2021年间，有626,090例慢性肝病相关死亡，其中ALD的年龄标准化死亡率（ASMR）在2010-2019年和2020-2021年间急剧增加（年度百分比变化[APC] 3.5%至17.6%，p < 0.01） ，导致观察到的 ASMR（每 10 万人）高于 2020 年（15.67 vs. 13.04）和 2021 年（17.42 vs. 13.41）的预测。NAFLD 的 ASMR 在大流行期间也有所增加（APC：14.5%），而乙型肝炎和丙型肝炎的发生率则下降。值得注意的是，ALD 的 ASMR 上升在非西班牙裔白人、黑人和阿拉斯加印第安人/美洲原住民中最为明显（APC：11.7%、10.8%、18.0%，全部为<0.05），NAFLD 的发病率相似但不太重要，而非西班牙裔亚洲人的发病率在 2010 年至 2021 年期间保持稳定（APC：4.9%）。ALD 的 ASMR 上升在 25-44 岁年龄组中尤为严重（APC：34.6%，而45-64 岁和 ≥65 岁则为 13.7% 和 12.6%，所有p <0.01），也都高于治疗前。 COVID-19 比率（所有p <0.01）。

结论

在 COVID-19 大流行期间，ALD 和 NAFLD 的 ASMR 以惊人的速度增加，其中年轻人、非西班牙裔白人和阿拉斯加印第安人/美洲原住民之间的差异最大。

影响和影响

此次大流行导致与 SARS-CoV-2 感染直接和间接相关的死亡人数增加。正如这项研究所示，在美国 COVID-19 大流行期间，酒精相关性肝病和非酒精性脂肪肝的年龄标准化死亡率大幅上升，远远超出了过去趋势预测的预期水平，尤其是在年轻人中。非西班牙裔白人和阿拉斯加印第安人/美洲原住民人口。然而，这一增长大部分与 COVID-19 没有直接关系。因此，对于当前的大流行及其恢复阶段，应优先考虑对慢性肝病患者进行定期监测和护理，并提高患者、护理人员、医疗保健系统和公共卫生政策制定者的认识。