Trends in Etiology-based Mortality From Chronic Liver Disease Before and During COVID-19 Pandemic in the United States

Clin Gastroenterol Hepatol. 2022 Oct;20(10):2307-2316.e3. doi: 10.1016/j.cgh.2022.05.045. Epub 2022 Jul 8.


Background & aims: During the global coronavirus disease 2019 (COVID-19) pandemic, patients with pre-existing chronic liver disease may represent a vulnerable population. We studied the etiology-based temporal trends in mortality of chronic liver disease and the underlying cause of death in the United States before and during the COVID-19 pandemic.

Methods: Population-based analyses were performed on United States national mortality records (2017-2020). Temporal trends in quarterly age-standardized mortality were obtained by joinpoint analysis with estimates of quarterly percentage change (QPC).

Results: Quarterly age-standardized all-cause mortality due to alcohol-related liver disease (ALD) initially increased at a quarterly rate of 1.1% before the COVID-19 pandemic, followed by a sharp increase during the COVID-19 pandemic at a quarterly rate of 11.2%. Likewise, steady increase in mortality of nonalcoholic fatty liver disease before the COVID-19 pandemic (QPC, 1.9%) accelerated during the COVID-19 pandemic (QPC, 6.6%). Although ALD-related mortality increased steeply compared with viral hepatitis-related mortality during the COVID-19 pandemic, the proportion of mortality due to COVID-19 among individuals with ALD was the lowest at 2.5%; more than 50% lower than viral hepatitis. The significant decline in all-cause mortality due to viral hepatitis before the COVID-19 pandemic plateaued during the COVID-19 pandemic due to increase in COVID-19-related mortality in individuals with viral hepatitis. Mortality due to cirrhosis increased markedly during the COVID-19 pandemic, mainly attributable to ALD.

Conclusion: All-cause mortality for ALD and nonalcoholic fatty liver disease rapidly accelerated during the COVID-19 pandemic compared with the pre-COVID-19 era. There has been a significant decline in viral hepatitis; however, a significant increase in COVID-related death in this population.

Keywords: Alcohol-related Liver Disease; Hepatitis B Infection; Hepatitis C Virus Infection; National Vital Statistic System; Nonalcoholic Fatty Liver Disease.

MeSH terms

  • COVID-19*
  • Hepatitis, Viral, Human* / complications
  • Hepatitis, Viral, Human* / epidemiology
  • Humans
  • Liver Cirrhosis / epidemiology
  • Liver Diseases, Alcoholic* / epidemiology
  • Non-alcoholic Fatty Liver Disease* / complications
  • Pandemics
  • United States / epidemiology