Chronic Liver Disease Mortality Rates Increased During COVID-19 Pandemic

Young, non-Hispanic White and Alaska Indian or Native American communities experienced an increase in nonalcoholic fatty liver disease and alcohol-associated liver disease mortality rates during the COVID-19 pandemic.

All-cause mortality rates in patients with chronic liver disease, specifically nonalcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease, have significantly increased during the COVID-19 pandemic, according to study findings published in the Journal of Hepatology.

Researchers used the National Vital Statistic System from the Centers for Disease Control and Prevention (CDC) WONDER platform and ICD-10 codes to obtain data for all liver disease-associated deaths from January 1, 2010 to December 31, 2021 in patients aged at least 25 years. Patients with alcohol-associated liver disease, NAFLD, hepatitis B virus (HBV), and hepatitis C virus (HCV) were included. Age, sex, race and ethnicity, and cause of death were recorded for all included patients.

For alcohol-associated liver disease, all-cause age-related standardized mortality rates (ASMR) per 100,000 persons increased from 9.49 to 17.42 in 2010 and 2021, respectively (average annual percentage change [APC], 5.9%; 95% CI, 5.1-6.7).

For NAFLD, all-cause ASMR increased throughout the study period but increased significantly after 2019 during the pandemic (APC, 14.5%; 95% CI, 1.1-29.6).

For viral hepatitis, all-cause ASMR remained stable or decreased.

Subgroup analysis indicated that non-Hispanic American Indian or Alaska Native individuals had the most significant increase in APC for alcohol-associated liver disease during 2018 to 2020 (18.0%; 95% CI, 6.1-31.4; P <.05), followed by non-Hispanic White, non-Hispanic Black, and non-Hispanic Asian individuals. For NAFLD, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic, and American Indian or Alaska Native individuals experienced an increase in all-cause ASMR, with APCs of 11.9%, 11.9%, 12.9%, 13.1%, and 10.9%, respectively.

By age, patients with alcohol-associated liver disease aged 25 to 44 years and patients with NAFLD aged 45 to 64 and 65 years and older had the highest increase in ASMR.

Study limitations include the inability to collect socioeconomic status and healthcare coverage data and the observational study design.

“The study found a decreasing trend in mortality for viral hepatitis but rising mortality for NAFLD and ALD [alcohol-associated liver disease] in the United States,” the study authors noted. “However, with the COVID-19 pandemic, the progress for viral hepatitis has slowed down, while the increasing mortality trend for ALD [alcohol-associated liver disease] and NAFLD became accelerated.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Pleases see the original reference for a full list of authors’ disclosures.


Gao X, Lv F, He X, et al. Impact of the COVID-19 pandemic on liver disease-related mortality rates in the United States. J Hepatol. Published online August 17, 2022. doi:10.1016/j.jhep.2022.07.28