The Pandemic Within the Pandemic

Sohal, Aalam; Khalid, Sameeha; Green, Victoria; Gulati, Alakh; Roytman, Marina

doi:10.1097/mcg.0000000000001627

Cited by 32 publications

(29 citation statements)

References 12 publications

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“…In a study of a privately insured population the prevalence of alcohol‐associated cirrhosis increased by 50% from 2009 to 2015 among women compared to only a 30% increase in men 38. Finally, hospital admissions for alcohol‐associated hepatitis have dramatically increased for women; among three community hospitals in California, there was a 125% increase in women hospitalized for severe acute alcohol‐associated hepatitis during the COVID‐19 pandemic 39…”

Section: Aldmentioning

confidence: 99%

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Health disparities in chronic liver disease

et al. 2022

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The syndemic of hazardous alcohol consumption, opioid use, and obesity has led to important changes in liver disease epidemiology that have exacerbated health disparities. Health disparities occur when plausibly avoidable health differences are experienced by socially disadvantaged populations. Highlighting health disparities, their sources, and consequences in chronic liver disease is fundamental to improving liver health outcomes.There have been large increases in alcohol use disorder in women, racial and ethnic minorities, and those experiencing poverty in the context of poor access to alcohol treatment, leading to increasing rates of alcoholassociated liver diseases. Rising rates of NAFLD and associated fibrosis have been observed in Hispanic persons, women aged > 50, and individuals experiencing food insecurity. Access to viral hepatitis screening and linkage to treatment are suboptimal for racial and ethnic minorities and individuals who are uninsured or underinsured, resulting in greater liver-related mortality and later-stage diagnoses of HCC. Data from more diverse cohorts on autoimmune and cholestatic liver diseases are lacking, supporting the need to study the contemporary epidemiology of these disorders in greater detail.Herein, we review the existing literature on racial and ethnic, gender, and socioeconomic disparities in chronic liver diseases using a social determinants of health framework to better understand how social and structural factors cause health disparities and affect chronic liver disease outcomes. We also propose potential solutions to eliminate disparities, outlining healthpolicy, health-system, community, and individual solutions to promote equity and improve health outcomes.

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Section: Aldmentioning

confidence: 99%

“… 38 Finally, hospital admissions for alcohol‐associated hepatitis have dramatically increased for women; among three community hospitals in California, there was a 125% increase in women hospitalized for severe acute alcohol‐associated hepatitis during the COVID‐19 pandemic. 39 …”

Section: Aldmentioning

confidence: 99%

Health disparities in chronic liver disease

et al. 2022

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“…Additionally, the pandemic has led to an overall increase in alcohol consumption and the incidence of AH. In a regional study [from Fresno, California] by Sohal et al, a 69% increase in AH-related hospitalization was noted after implementation of stay-at-home orders [ 31 ]. More specifically, there was a 100% increase in hospitalization of patients under 40 years old and a 125% increase in female patients; only a 34% rise was noted in males [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a regional study [from Fresno, California] by Sohal et al, a 69% increase in AH-related hospitalization was noted after implementation of stay-at-home orders [ 31 ]. More specifically, there was a 100% increase in hospitalization of patients under 40 years old and a 125% increase in female patients; only a 34% rise was noted in males [ 31 ]. It is hypothesized that the younger individuals and females experienced a higher burden of economic, social, and psychological stressors from the pandemic, which led to increased alcohol use.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Acute Alcoholic Hepatitis vs. Non-Alcoholic Hepatitis Patients from a Cohort with Chronic Alcohol Dependence

Tun

Dossaji

Massey

et al. 2023

Genes

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The rate of alcoholic hepatitis (AH) has risen in recent years. AH can cause as much as 40–50% mortality in severe cases. Successful abstinence has been the only therapy associated with long-term survival in patients with AH. Thus, it is crucial to be able to identify at-risk individuals in order to implement preventative measures. From the patient database, adult patients (age 18 and above) with AH were identified using the ICD-10 classification from November 2017 to October 2019. Liver biopsies are not routinely performed at our institution. Therefore, patients were diagnosed with AH based on clinical parameters and were divided into “probable” and “possible” AH. Logistic regression analysis was performed to determine risk factors associated with AH. A sub-analysis was performed to determine variables associated with mortality in AH patients. Among the 192 patients with alcohol dependence, there were 100 patients with AH and 92 patients without AH. The mean age was 49.3 years in the AH cohort, compared to 54.5 years in the non-AH cohort. Binge drinking (OR 2.698; 95% CI 1.079, 6.745; p = 0.03), heavy drinking (OR 3.169; 95% CI 1.348, 7.452; p = 0.01), and the presence of cirrhosis (OR 3.392; 95% CI 1.306, 8.811; p = 0.01) were identified as characteristics more commonly found in the AH cohort. Further, a higher inpatient mortality was seen in those with a probable AH diagnosis (OR 6.79; 95% CI 1.38, 44.9; p = 0.03) and hypertension (OR 6.51; 95% CI 9.49, 35.7; p = 0.02). A higher incidence of mortality was also noted among the non-Caucasian race (OR 2.72; 95% CI 4.92; 22.3; p = 0.29). A higher mortality rate despite a lower incidence of alcohol use among non-Caucasian patients may indicate healthcare disparities.

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“…In one study of three large California hospitals, there was a 51% increase in patients admitted for AH from the years 2019 to 2020, with women and patients younger than 40 years having the greatest percent increases (age < 40: 2019, 22.9%; 2020, 30.4%; women: 2019: 18.3%, 2020: 27.7%). 60 With the increase in ALD during the COVID-19 era, ALD transplants increase in COVID era, outpacing non-ALD transplant. 53 61 In the early pandemic period (March to January 2021), there was a 60% increase in the number of patients waitlisted and transplanted with AH, while non-ALD and AC stayed within expected ranges pre- and post-pandemic.…”

Section: Epidemiology Of Alcohol Usementioning

confidence: 99%

The Changing Epidemiology of Alcohol-Associated Liver Disease: Gender, Race, and Risk Factors

Anouti

Mellinger

2022

Semin Liver Dis

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Cases of alcohol-associated liver disease (ALD) are increasing at a steady rate in the United States with more patients presenting with alcohol-associated hepatitis (AH) and alcohol-associated cirrhosis (AC). While alcohol use has increased across many demographic groups, women are suffering from a greater increase in alcohol use disorder (AUD), and are at a greater risk of ALD due to pathophysiological differences which include absorption of alcohol, first pass metabolism, and hormonal differences. Differences across race have also been found with Native Americans and Hispanics suffering from some of the largest increases in ALD rates. Younger adults are heavily impacted by rising rates of both AUD and ALD. Comorbidities such as obesity and NASH have been shown to augment the deleterious effects of AUD and ALD, resulting in more advanced liver disease. Finally, COVID-19 and policies related to the pandemic have resulted in increased AUD across many cohorts, which has itself resulted in marked increases in ALD. In conclusion, ALD rates are rising, with young people and women particularly impacted.

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The Pandemic Within the Pandemic

Cited by 32 publications

References 12 publications

Health disparities in chronic liver disease

Health disparities in chronic liver disease

A Comparative Study of Acute Alcoholic Hepatitis vs. Non-Alcoholic Hepatitis Patients from a Cohort with Chronic Alcohol Dependence

The Changing Epidemiology of Alcohol-Associated Liver Disease: Gender, Race, and Risk Factors

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