By Eli Cahan
Kaiser Health News
April 27, 2021
Alcoholism-related liver disease was a growing problem even before the pandemic, as 15 million people suffer with the condition around the country, and as hospitalizations have doubled over the past decade.
But the pandemic has dramatically added to the toll. Although national figures are not available, admissions for alcoholic liver disease at Keck Hospital of the University of Southern California were up 30% in 2020 compared with 2019, said Dr. Brian Lee, a transplant hepatologist who treats the patients hospitalized with the condition.
Since the metabolism of alcohol varies among individuals, these diseases can show up after only a few months of heavy drinking. Some people can drink heavily without experiencing side effects for a long time; others can suffer inflammatory reactions that rapidly send them to the hospital.
Leading liver disease specialists and psychiatrists believe the isolation, unemployment and hopelessness associated with Covid-19 are driving the explosion in cases.
A trend toward increased disease in people younger than 40 “has been alarming for years,” said Dr. Raymond Chung, a hepatologist at Harvard University and president of the American Association for the Study of Liver Disease. “But what we’re seeing now is truly dramatic.”
Dr. Haripriya Maddur, a hepatologist at Northwestern University, has also treated numerous young adults hospitalized with the jaundice and abdominal distension emblematic of the disease. She attributes this pattern to the pandemic-era intensification of economic struggles faced by the demographic: at the same time that these young adults may be entering the housing market or starting a family, entry-level employment—particularly in the hospitality industry that’s been crippled by lockdowns—is increasingly hard to come by.
Women may also be suffering disproportionately from alcoholic liver disease during the pandemic. This is in part because they metabolize alcohol at slower rates than men: lower levels of the enzyme responsible for degrading ethanol leads to higher levels of toxin in the blood and, in turn, more extensive organ damage in women than in men who drink the same amount.
It is also due to social circumstances, since the “stress of the pandemic has, in some ways, particularly targeted women,” said Dr. Jessica Mellinger, a hepatologist at the University of Michigan. Lower wages, less job stability and the burdens of parenting tend to fall more heavily on women’s shoulders, she said.
“If you have all of these additional stressors, with all of your forms of support gone—and all you have left is the bottle—that’s what you’ll resort to,” Mellinger said. “But a woman who drinks like a man gets sicker faster.”
Nationwide, more adults are turning to the bottle during the pandemic: One study found rates of alcohol consumption in spring 2020 were up 14% compared with the same period in 2019, and drinkers consumed nearly 30% more than in pre-pandemic months.
These relapses, and the hospitalizations they cause, can be life-threatening. More than 1 in 20 patients with alcohol-related liver failure die before leaving the hospital, and alcohol-related liver disease is the leading cause for transplantation.
The disease also makes people more susceptible to COVID-19: Patients with liver disease die of COVID-19 at rates three times higher than those without it, and alcohol-associated liver disease has been found to increase the risk of death from COVID-19 by an additional 79% to 142%.
Some physicians, like Lee at USC, are concerned the stressors leading to increased alcohol consumption and liver disease may stretch well into the future—even after lockdowns lift.
“The vaccine is coming to a pharmacy near you, COVID-19 will end, and things will begin to get back to normal,” he said. “But the real question is whether public health authorities decide to act in ways that combat [alcoholic liver disease].”
“Because people are just fighting to cope day-to-day right now.”
Reprinted with permission from KHN (Kaiser Health News) a non-profit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.