Alcohol Associated Hepatitis Trends Before and Following the Onset of the COVID-19 Pandemic Across Two Distinct Cohorts in the United States and Hong Kong

Abstract

Background and AimsAlcohol-associated liver disease (ALD) burden has been rising globally, fueled by increases in high-risk alcohol use following the COVID-19 pandemic. We aim to evaluate trends in annual incidence of alcohol-associated hepatitis (AH) before and following onset of the COVID-19 pandemic across two geographically distinct populations in the U.S. and Hong Kong. MethodsUsing U.S. national Veterans Affairs (VA) data and Hong Kong territory-wide data, trends in annual incidence of AH were evaluated from 2000 to 2023. AH was identified using a combination of ICD-9/10 diagnostic codes, laboratory data, and available alcohol use data. ResultsAmong the VA, annual incidence of AH rose steadily from 39.4 to 53.7 per 100,000-persons (2010 to 2020), then declined to 36.2 per 100,000-persons in 2023. Annual AH incidence was substantially lower in Hong Kong, but demonstrated similar trends, peaking at 0.28 per 100,000-persons during the first year of the pandemic. Among both cohorts, incidence of AH was significantly higher in men vs. women, but particularly for the VA cohort, the rise in AH incidence was more rapid in women. Among both cohorts, the highest incidence of AH in 2023 was among the age 40-49 years group (VA: 72.7 per 100,000-persons; Hong Kong: 1.89 per 100,000-persons). ConclusionsWe provide a comprehensive analysis of epidemiological trends in AH incidence across two distinct populations, highlighting the need for continued awareness of targeted interventions to curb unhealthy alcohol use and its complications. Impact and ImplicationsAlcohol-associated hepatitis (AH) is a severe complication of high-risk alcohol use associated with significant morbidity and mortality. Increasing alcohol use fueled by the COVID-19 pandemic has led to parallel increases in alcohol-related co-morbidities. The current study provides a comprehensive analysis of trends in the incidence of AH across two distinct world regions before and following the onset of the COVID-19 pandemic. Better identifying epidemiological trends in AH incidence as well as highlighting populations most effected can help target public health resources and health system interventions to address the dangers of high-risk alcohol use more effectively.