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Alcohol Dependence More Frequent in
UK Inpatients During Than Before COVID
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EASL International Liver Congress, June 23-26, 2021
Mark Mascolini
Alcohol dependence proved more frequent among hospital inpatients during than before the COVID-19 pandemic, according to results of a large retrospective study in Nottingham, England [1]. During the pandemic, inpatients with test-measured alcohol-use disorder (AUD) ran a higher risk of alcohol-related mental health diagnoses than AUD inpatients before the pandemic.
Per-person alcohol sales rose 29% in England during the COVID-19 pandemic, according to public health data cited by University of Nottingham researchers who conducted this retrospective study. After the pandemic arrived, 8.4 million people drank alcohol at an increased risk level, compared with 4.8 million before the pandemic. Alcohol-related liver disease referrals to a tertiary liver unit rose significantly after COVID-19 swept through Britain. And the alcohol-specific death rate rose 18.2% from 2019 to 2020, as the pandemic took hold.
The Nottingham researchers set out to describe the impact of the COVID-19 pandemic on AUD in people admitted to the hospital by comparing a prepandemic cohort (April 1 to October 31, 2019) with a pandemic cohort (April 1 to October 31, 2020). Everyone admitted to the hospital since 2018 had alcohol use measured by AUDIT-C score, for which 0-4 means low risk, 5-7 increased risk, 8-10 high risk, and 11-12 dependence. Any score above 4 indicates AUD. The researchers determined variation in AUDIT-C by age, sex, ethnicity, and admission type (medical or surgical). All study participants were 16 years old or older.
The analysis involved 36,578 prepandemic admissions (27,356 individuals) and 27,349 admissions during the pandemic (20,598 individuals) (admissions 57.2% vs 42.8%, P < 0.001). The proportion of men admitted to the hospital rose significantly from 47.6% before the pandemic to 49.3% during the pandemic (P < 0.001). About 91% of inpatients during both periods were white.
Overall AUD (any AUDIT-C score above 4) proved less frequent among people admitted to the hospital during the pandemic than before (17.6% vs 18.4%, P = 0.008). But the proportion of men admitted with AUD proved significantly higher during than before the pandemic (69.6% vs 66.5%, P = 0.003). And the proportion of people with alcohol dependence (AUDIT-C score 11-12) proved significantly higher during than before the pandemic (3.7% vs 3.0%, P < 0.001).
During the pandemic 66.3% of admissions with AUD came through the emergency room versus 56.0% before the pandemic, while the proportion of AUD admissions via other routes was lower during the pandemic than before the pandemic (33.7% vs 44.0%) (P < 0.001 overall for pandemic vs prepandemic).
Among people with AUD, a significantly higher proportion had a primary diagnosis of mental and behavioral disorders due to alcohol during the pandemic than before (3.5% vs 2.4%, P = 0.002). Among people with alcohol dependence (AUDIT-C score 11-12), a higher proportion during than before the pandemic had a primary diagnosis of mental and behavioral disorders due to alcohol (13.4% vs 11.3%).
Among people admitted to the hospital without COVID-19, average age was significantly younger in those with AUD (AUDIT-C score 5-12) than in those at low risk for AUD (AUDIT-C score 0-4) (56 vs 65, P < 0.001), and the same proved in people admitted with COVID-19 (62 vs 70, P < 0.001). But COVID-19 inpatients with AUD were significantly older than COVID-19-negative inpatients with AUD (62 vs 56, P = 0.0024). Dying in the hospital was significantly more frequent with than without COVID-19 both in people with AUD (25.0% vs 4.4%, P < 0.001) and in those at low risk for AUD (26.8% vs 7.6%, P < 0.001).
Overall average age lay higher in inpatients with than without COVID-19 (68.9 vs 63.4 years). But among people who died in the hospital with COVID-19, age proved significantly lower in those with AUD (AUDIT-C score 5-12) than in those at low risk for AUD (AUDIT-C score 0-4): 63.9 versus 71.6 years.
Reference
1. Subhani M, Sheth A, Unitt S, Aithal GP, Ryder S, Morling JR. Effect of COVID-19 on alcohol use disorder among hospitalised patients: a retrospective cohort control study. EASL International Liver Congress, June 23-26, 2021. Abstract OS-1381.
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