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A higher proportion of people hospitalized in the U.K. during the pandemic had alcohol dependence compared with pre-pandemic times, and these patients were more likely to have mental health issues and worse COVID-19 outcomes, a retrospective study found.
Alcohol dependence at admission increased from 3% in pre-pandemic times to 3.7% during the pandemic (P<0.001), and patients hospitalized with alcohol use disorder (AUD) had a 16-fold increased risk of mental health and behavioral problems (OR 15.8, P<0.001), reported Mohsan Subhani, MBBS, of the University of Nottingham in England.
COVID-19 patients with AUD had longer hospital stays than those without AUD, and amongst those who died of COVID-19, patients with AUD were significantly younger, by 8 years on average (P=0.05 for both), according to a presentation at the virtual European Association for the Study of the Liver International Liver Congress.
“Our study highlights the impact of the COVID-19 pandemic on drinking behaviors. A higher proportion of those admitted during this pandemic were alcohol dependent and admitted as a medical emergency,” Subhani and colleagues concluded in their abstract. “Overall patients were from higher socioeconomic status and, if they had COVID-19 infection, died at a significantly younger age.”
Increasing alcohol consumption has been common during the pandemic, as people find ways to cope with stress and loss, Sajid Jalil, MBBS, MS, of the Ohio State University College of Medicine Wexner Medical Center in Columbus, told MedPage Today. Alcoholic hepatitis commonly arises from severe alcohol use disorder, but in younger patients usually comes with a better prognosis, he said.
“What is surprising about this study is that younger patients are just as vulnerable and [this] may point to the hepatotropism of SARS-COV-2 and immune-mediated injury. An increased awareness in the medical community will improve vigilance for bad outcomes,” said Jalil, who added that other recent studies have found higher mortality rates from COVID-19 among patients with alcoholic liver disease, chronic liver disease, or cirrhosis.
Alcohol-specific mortality rates have been rising in the U.K. since 2001, increasing 20% last year alone, and this trend has been a growing concern throughout the pandemic, Subhani explained.
“More representative data from hospitalized patients is lacking,” he told MedPage Today. “We aimed to describe the immensity of alcohol use disorder in the hospital setting and explore the impact of the pandemic.”
One recent study from researchers in Spain found that patients with both AUD and COVID-19 had a higher odds of extending their hospital stay by at least 1 day and a 3.15-fold higher risk of developing a least one neuropsychiatric symptom.
Subhani said his team’s study showed a shift in the social and demographic distribution of AUD during the pandemic.
“We believe this will help the social segmentation for alcohol use disorder and [delivery of] targeted alcohol services. Targeting high-risk groups by early identification followed by intervention provides the best opportunity to reduce the number of patients presenting with end-stage liver disease and other harm related to alcohol misuse,” he noted.
For the study, the researchers compared electronic health records data in two groups of patients admitted to Nottingham University Hospital: a pre-pandemic cohort of 27,356 patients (April to October 2019) and a pandemic cohort involving 20,598 patients (April to October 2020).
AUDIT-C for alcohol use assessments were given to all the patients, who were categorized as one of the following:
- Low-risk (scores of 0-4)
- Increased-risk (5-7)
- High risk (8-10)
- Alcohol dependent (11-12)
Scores of 5 or greater were considered positive for AUD.
The most common mode of admission for patients was through the emergency department. AUD patients during the pandemic were also more likely to be in a stable relationship (i.e., married, civil union, etc.) and have mental health issues.
Patients in the higher-risk groups were younger than those in the low-risk group (average age 56 vs 64 years), and patients with AUD were more likely to be white and male (94% and 66%, respectively; P<0.001).
The results reflect population trends observed in Europe as well as in high-income countries, including the U.S., Subhani said. “We believe the results are generalizable to the American population.”
Study limitations, he said, included the single-center design, and the fact that patients in intensive care were excluded.
Next steps for the team, Subhani said, are to present the results to “local and national policymakers to encourage easy access to alcohol service specialists and to increase the number of services and the amount of funding. We aim to collect the latest data to see trends throughout the pandemic,” he added.
Créditos: Comité científico Covid