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

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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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  1. SciScore for 10.1101/2021.03.18.21253887: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Experimental Models: Cell Lines
    SentencesResources
    DALYs — a combined measure of disability, prevalence of disease (in our case decompensated cirrhosis and HCC), and quantity of life-years lost due to disease and mortality34-36— were calculated using disability weights from 2016 Global Burden of Disease study values for decompensated cirrhosis and HCC.37 Life-years lost due to disease and mortality (YLL) were estimated by multiplying each death by the remaining life expectancy at the age of death and summing across the years.
    HCC.37
    suggested: None
    Software and Algorithms
    SentencesResources
    (Supplement tables 1 and 2) We estimated individual drinking levels using the NESARC studies,9 limited access datasets obtained from the National Institute on Alcohol Abuse and Alcoholism, which are nationally representative surveys of at least 36,309 US adults collected between 2001-2002 (NESARC-I Wave 1) and April 2012 and June 2013 (NESARC-III).
    NESARC
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    To mitigate this limitation, we model the uncertainty in our estimates with extensive and conservative probabilistic sensitivity analysis. Second, there are other (unaccounted) factors that could impact the risk of ALD-related decompensation. The significant turmoil of this moment in the United States caused by COVID-19, and the associated economic and political stressors, may have had disproportionate impact on individuals at increased risk of adverse health outcomes.29 Individuals often increase alcohol intake to cope with emotional stress and chronic uncertainty; these coping mechanism have unclear long-term consistency30. To address this concern, our increased consumption scenario only increases drinking for one year whereupon drinking transitions return to the pre-2020. Third, this modelling study does not account for the impact of COVID-19 infection on those with pre-existing cirrhosis or those at-risk for future decompensation. Fourth, we do not model the impact of adverse trends on alcohol consumption on specific population subgroups. Given recent complementary results by Barbosa et al.,16 a particular focus on at risk groups including females, Black people, and households with children, should be taken as increased morbidity and mortality beyond the status quo should be expected to be concentrated in populations with the greatest increase in consumption and fibrosis susceptibility. While the study does not specifically address the impacts in at risk communities, the ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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