Effect of Increased Alcohol Consumption During COVID-19 Pandemic on Alcohol-related Liver Disease: A Modelling Study
Authors: Julien Jovan , Ayer Turgay , Tapper Elliot B , Barbosa Carolina , Dowd William , Chhatwal Jagpreet 
Published: March 2021

AbstractObjectivesThe burden of alcohol-related liver disease (ALD) is surging in the US. There is evidence that alcohol consumption increased during the early periods of the coronavirus disease-2019 (COVID-19) pandemic. We describe the impact of increased alcohol consumption on alcohol-related liver disease.DesignMicrosimulation modelSettingModel parameters estimated from publicly available data sources, including national surveys on drug and alcohol use and published studies informing the impact of alcohol consumption on ALD severity.ParticipantsUS residentsMethodsWe 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 US born between 1950-2012. We modelled 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 April 2020. We compared these outcomes with a counter-factual scenario wherein no COVID-19 occurs, and drinking patterns do not change. Reported outcomes are for individuals aged 18-65.Main outcome measuresALD-related deaths inclusive of HCC mortality, the prevalence and incidence of decompensated cirrhosis and hepatocellular carcinoma, and disability-adjusted life-years (DALYs)ResultsIncreases in alcohol consumption during 2020 due to the COVID-19 pandemic are estimated to result in to 8,200 [95% UI 7,700 – 8,700] additional ALD-related deaths (1% increase compared with the counter-factual scenario), 17,100 [95% UI 16,100 – 18,200] cases of decompensated cirrhosis (2% increase) and 1,100 [95% UI 1,100 – 1,200] cases of HCC (1% increase) between 2020 and 2040. Between 2020 and 2023, alcohol consumption changes due to COVID-19 will lead to 100 [100-200] additional deaths and 2,200 [2,200-2,300] additional decompensations in patients suffering from alcohol-related liver disease.ConclusionsA 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 US.Summary Box”What is already known on this topicThe impact of an increase in alcohol consumption during coronavirus disease 2019 (COVID-19) on drinking trajectory changes and alcohol-related liver diseases is not known.Studies have reported increases in hospital admissions for alcohol-related liver disease or pancreatitis potentially related to COVID-19, increases in alcohol consumption, and exacerbation of pre-existing liver injury, though limited evidence exists for the long-term effect of increased drinking on alcohol-related liver cirrhosis and liver cancer in the USA.Added value of this studyOur study provides new data on liver disease morbidity and mortality associated with increased consumption of alcohol during the COVID-19 pandemic.Our study suggests that drinking changes associated with the COVID-19 pandemic it is expected to lead to increases in both mortality and morbidity in the long term. to 8,200 additional ALD-related deaths, 17,100 cases of decompensated cirrhosis, and 1,100 cases of HCC between 2020 and 2040 2