Alcohol-Associated Liver Disease Soared With COVID-19

Laird Harrison

August 11, 2022

Alcohol abuse and the liver disease that results from it both accelerated during the COVID-19 pandemic, a review of the research shows.

The emotional stress and social isolation of the pandemic combined with reduced access to mental health services worsened trends in alcohol-related disease, according to lead author Sasha Deutsch-Link, MD, a gastroenterology fellow at the University of North Carolina, and colleagues.

"In the US, we need a united and collaborative effort to prevent harmful alcohol use and treat prevalent alcohol use disorder in patients with and without liver disease," they write.

The review was published online August 3 in the journal Digestive and Liver Disease.

For reasons that remain unclear, alcohol use disorder had been increasing even before the COVID-19 pandemic. From 8.5% in 2001-2002, the 12-month prevalence had risen to 12.7% in 2012-2013. The prevalence of alcohol-associated cirrhosis and liver transplantations was rising in step.

When the virus hit, many people lost their jobs, while many more lost the benefit of face-to-face contact with friends, family, and colleagues. Researchers found a link between subjective feelings of distress and harmful alcohol use. Alcohol sales in the United States shot up from $7.1 billion in 2019 to $9.5 billion in 2020, a trend that was mirrored in many other countries.

At the same time, patients reported less access to self-help groups like Alcoholics Anonymous, intensive outpatient treatment, and residential treatment centers.

For fear of COVID-19, some patients avoided treatment for liver disease, especially at the beginning of the pandemic, but hospitals still saw more patients with related diagnoses. At three hospitals in Fresno, California, admissions for alcohol-associated hepatitis admissions increased by 51% from 2019 to 2020.

Nationwide during that time, deaths from alcohol-associated liver disease increased by one quarter, and transplants for severe alcohol-associated hepatitis increased by one half. Liver donations decreased, and waiting lists lengthened.

Acute-on-chronic liver failure admissions increased modestly during the pandemic, but the proportion caused by alcohol-associated hepatitis increased by more than half.

Alcohol use disorder and alcohol-associated liver disease affected COVID-19 as well, increasing the risk for infection, inflammation, and mortality.

The prevalence of alcohol abuse and resulting liver disease have historically been higher among men than in women, but that gap narrowed during the pandemic.

At the same time, the prevalence of alcohol-associated hepatitis increased disproportionately among Black people and women, and the increase in alcohol-associated liver disease disproportionately affected Indigenous men and women, Asian men, and Hispanic women.

In response to these dangerous trends, Deutsch-Link and colleagues cite studies on the benefits of telehealth for providing specialty hepatology care and alcohol abuse treatment. Acknowledging that not all patients have stable housing or internet access, they suggest screening to determine appropriate care.

Alcohol taxes and public messaging could also reduce alcohol consumption, they add.

They recommend that primary care physicians and gastroenterologists focus more effort on substance abuse through standardized screening, brief interventions or advice, and referral to treatment.

The authors reported support from the National Institutes of Health, and outside the submitted work personal fees from Gilead, Medscape Gastroenterology, Chronic Liver Disease Foundation, Up-to-Date, and Merck.

Dig Liver Dis. Published online August 3, 2022. Full text

Laird Harrison writes about science, health and culture. His work has appeared in national magazines, in newspapers, on public radio and on websites. He is at work on a novel about alternate realities in physics. Harrison teaches writing at the Writers Grotto. Visit him at or follow him on Twitter: @LairdH

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