Across the country, including right here in Florida, there has been a spike in alcohol-related liver disease deaths since the start of the pandemic.
"It was quite noticeable relatively early in the pandemic," said Dr. Andreas Zori, a gastroenterologist with the University of Florida Health. "Especially, we saw an increase in acute alcoholic hepatitis, which is life-threatening acute inflammation in the liver."
According to the National Institute on Alcohol Abuse and Alcoholism, alcohol sales grew tremendously from 2020 to 2022 in the United States, and as sales increased, so too did death rates associated with liver disease.
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In Florida, there were 3,500 people in the state who died due to alcohol-related liver disease between 2018 and 2019, according to the Centers for Disease Control and Prevention. During the pandemic years from 2020 to 2022, the total nearly doubled to over 6,300.
During that time, Florida's population also grew dramatically. Looking at the crude rate shows Florida observed a 1.4% increase in death rates keeping pretty close to the national pace of a 2% growth from before the pandemic and until 2022.
Why did rates go up?
As for why alcohol consumption increased, Zori said there's no one answer.
"As with most things, I think the cause was multifactorial but there were several themes," he said. "Patients early in recovery lost access to support and counseling services. This was particularly harmful to patients in early recovery."
Zori also noted many factors led to increased alcohol usage such as stress, loss of jobs, decreased social interactions, and difficulty accessing mental health services.
Additionally, Florida also used different quarantine practices, which may have contributed to the problem, said Elena Cyrus, a statistician epidemiologist at the University of Central Florida.
"We were one of the very first states to be open, and having that amount of immigration coming into our state more so than others," she said. "We didn't have that protection of quarantine as long as other places did. So we have that and then we have huge amounts of economic inflation, which is relevant here. because what it does is that it causes a lot of stress."
That stress, she believes, led many to turn toward alcohol for comfort.
"I think, you know, when you look at those numbers on the surface, is really telling a much deeper story of almost a systemic breakdown, that manifests itself clinically," she said.
"COVID: the great effect modifier"
According to CDC data, some counties suffered more than others like Charlotte County, which experienced a 6% increase in death rates.
In Central Florida, Brevard and Volusia ranked amongst the countries with the highest death rates. Between 2020 and 2022, Brevard observed a rate of 16% per 100,000 people — a 4% increase from its 2018-19 numbers. Volusia reported 15.4% but did not observe a change from prior to the pandemic.
However bleak the numbers may be, it seems COVID-19 exacerbated an already existing issue, Cyrus said.
“So COVID-19, in some instances with alcohol use specifically might have accelerated a trend that we were already seeing in terms of alcohol-related deaths, especially as marked by liver disease,” she said.
Cyrus refers to COVID as "the great effect modifier," because of how disruptive the virus became in many different facets of life. In terms of alcohol consumption, there was already a steady rise prior to 2020, Cyrus said.
"And then from 2020 to 2021, we continue to see an increase, but it was almost like a spike, like a sharp line, moving almost vertically," she said.
Other factors
Cyrus said the numbers are only part of the story as different vulnerable populations also suffered greatly. Cyrus’ research showed transgender women experienced a huge increase in dangerous alcoholic consumption during this time.
“They were beyond they were outside of the maximum limit of what we would consider harmful use, and actually what we would maybe want to refer into rehabilitation or into clinical services for," she said.
More research is required in understanding how different populations may have been impacted.
While there is a link between COVID, alcohol and liver-disease deaths, Cyrus said it is unclear how much of the link may be also related to socioeconomics, genetic disposition, diet or any number of other complicating factors.
In addition to increased alcohol consumption, the rising death rate may also have come as a result of COVID or long COVID. Research shows that sometimes liver disease can manifest as an anti-inflammatory reaction to a virus, including COVID-19.
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