Alcoholic Liver Disease Death Rates Surged During the Pandemic | Healthiest Communities Health News

By Phillip Reese | KFF Health News

Excessive drinking during the COVID-19 pandemic appears to have increased alcoholic liver disease deaths so much that the condition killed more Californians than car accidents or breast cancer, a KFF Health News analysis has found.

Lockdowns made people feel isolated, depressed, and anxious, leading some to increase their alcohol intake. Alcohol sales rose during the pandemic, with especially large jumps in the consumption of spirits.

While this led to a rise in all sorts of alcohol-related deaths, the number of Californians dying from alcoholic liver disease spiked dramatically, with 14,209 deaths between 2020 and 2022, according to provisional data from the Centers for Disease Control and Prevention.

Alcoholic liver disease is the most common cause of alcohol-induced deaths nationally. In California, the death rate from the disease during the last three years was 25% higher than in the three years before the pandemic. The rate peaked at 13.2 deaths per 100,000 residents in 2021, nearly double the rate from two decades ago. Nationally, the rate reached 10 deaths per 100,000 residents the same year, up from 7.3 per 100,000 in 2019 and 4.4 per 100,000 in 2006.

The disease is usually caused by years of excessive drinking, though it can sometimes occur after a short period of heavy alcohol use. There are often no symptoms until late in the disease, when weakness, confusion and jaundice can occur.

Lee and other researchers found a connection between alcoholic liver disease and metabolic syndrome, a condition often characterized by excess body fat around the waist. Metabolic syndrome — often caused by poor diet and an inactive lifestyle — has risen across the country.

“Having metabolic syndrome, which is associated with obesity, high blood pressure and diabetes, more than doubles your risk of having advanced liver disease at the same level of drinking,” Lee said.

The Californians alcoholic liver disease most often kills are those between 55 and 74 years old. They make up about a quarter of the state’s adults but more than half the deaths from alcoholic liver disease.

However, death rates among Californians 25 to 44 roughly doubled during the last decade. About 2,650 Californians in that age group died of the disease during the last three years, compared with 1,270 deaths from 2010 through 2012.

“People are drinking at earlier levels,” Lee said. “People are developing obesity at younger ages.”

The highest death rates from alcoholic liver disease occur in rural eastern and Northern California. In Humboldt County, for instance, the death rate from alcoholic liver disease is more than double the statewide rate.

Jeremy Campbell, executive director of Waterfront Recovery Services in Eureka, said Humboldt County and other rural areas often don’t have the resources and facilities to address high rates of alcohol use disorder. His facility provides high-intensity residential services and uses medication to get people through detox.

“The two other inpatient treatment facilities in Eureka are also at capacity,” he said. “This is just a situation that there’s just not enough treatment.”

Campbell also pointed to the demographics of Humboldt County, which has a much higher proportion of white and Native American residents than the rest of the state. Alcoholic liver disease death rates in California are highest among Native American and white residents.

Death rates rose more among Native American, Latino, Asian and Black Californians during the last decade than among non-Latino white Californians, CDC data shows. Part of that is due to disparities in insurance coverage and access to care, said Lee. In addition, Lee said, rates of metabolic syndrome have increased more quickly among nonwhites than among whites. Racial health disparities also manifest in differing survival rates for Black and white patients after liver transplants, he added.

The trend is expected to continue. Julien projects a temporary dip in deaths because many people who would have died of the disease in 2022 or 2023 instead died sooner, after a boost in drinking during the pandemic, but that deaths will rise later as bad habits developed during the pandemic begin to take a long-term toll.

“As people increased their consumption during COVID-19, we have more folks who have now initiated alcohol use disorder,” Julien said.