S1226 Increasing Prevalence and Racial Disparity of Alcoholic Gastrointestinal and Liver Diseases During the COVID-19 Epidemic

Abstract

Introduction: The COVID-19 epidemic drastically altered the social structure in the United States beginning in mid-2020. One well-documented consequence of stay-at-home orders and social distancing was an increase in alcohol consumption. We postulated that this increase in alcohol consumption would be associated with a rise in alcohol-related gastrointestinal (GI) and liver diseases. Methods: We queried a commercial database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from major integrated US healthcare systems from 1999 to June 2021. We identified aggregated cohorts of patients with four alcohol-related GI and liver disorders (“alcoholic hepatitis”, “bleeding esophageal varices”, “inflammation of pancreas caused by alcohol”, and “alcoholic gastritis”), based on Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT). From these cohorts, we compared patients utilizing healthcare during the COVID-19 epidemic (June 21st, 2020-June 20th, 2021) to patients largely unaffected by COVID-19 (prior to June 21st, 2020). Results: We identified 8,445,720 patients treated from June 21st, 2020-June 20th, 2021 (“Covid Cohort”) and 65,587,860 patients treated prior to June 21st, 2020 (“Pre-Covid Cohort”). These groups were similar with regard to age and race, with the exception of African American patients, who were more likely to be treated for all causes during COVID-19 (OR 1.65; P < 0.0001). Each alcohol-related disorder was significantly more likely to occur in the Covid Cohort than the Pre-Covid Cohort: alcoholic hepatitis (OR 2.77), bleeding esophageal varices (OR 1.55), alcoholic pancreatitis (OR 3.67), and alcoholic gastritis (OR 1.70) [for each disorder, P < 0.0001]. African Americans in the COVID-19 cohort were much more likely to be diagnosed with alcoholic hepatitis (OR 2.63), bleeding esophageal varices (OR 1.51), alcoholic pancreatitis (OR 2.17), and alcoholic gastritis (OR 3.09) [for each disorder, P < 0.0001]. Conclusion: These findings show that the prevalence of alcohol-related liver and GI disease increased during the COVID-19 epidemic. Although causation cannot be established from these data, we suspect that these increases are associated with increased alcohol consumption resulting from social distancing, isolation, and resultant depression. Importantly, these data show that COVID-19 disproportionately affected African-Americans, both in terms of overall healthcare utilization and increased burden of alcohol related liver and GI disease.Table 1.: Prevalence and Demographics of Alcoholic Gastrointestinal (GI) and Liver Diseases "Pre-COVID" and During COVID.