The Impact of the COVID-19 Epidemic on Hospital Admissions for Alcohol-related Liver Disease and Pancreatitis in Western Sydney

The paper examines whether the COVID-19 pandemic and associated public health restrictions in New South Wales, particularly in Western Sydney, were associated with changes in emergency admissions for alcohol-related liver disease (ALD) and pancreatitis. The context includes widespread anxiety, stress, social isolation, and reports of increased alcohol sales and consumption during the pandemic. International data suggested rising alcohol-related harms, prompting investigation of local hospital admission trends.

The authors cite increases in alcohol consumption and alcohol-related harms reported internationally during COVID-19: record rises in alcohol-specific mortality in the UK in 2020; increased alcohol consumption in British Columbia, Canada, and doubling of ALD hospitalizations in Alberta during the first wave; and increased hospital admissions for ALD and acute pancreatitis in Japan. An Australian survey indicated increased alcohol use among parents in 2020. A report from Victoria, Australia, noted a higher proportion of alcohol-related acute pancreatitis during lockdowns.

Retrospective observational analysis of emergency admissions to four public hospitals in Western Sydney (Auburn Hospital, Blacktown Hospital, Mount Druitt Hospital, Westmead Hospital). Adults aged ≥18 years admitted between January 1, 2018 and December 31, 2021 were included. Data extracted included medical record number, age, gender, ethnicity, admission/discharge status, cause of admission, and primary diagnosis. Primary diagnoses examined were ALD (ICD-10 K70.1, K70.3, K70.4, K70.7, K70.9) and pancreatitis (alcoholic acute pancreatitis K85.2; other acute pancreatitis K85.0, K85.1, K85.3, K85.8, K85.9; alcohol-induced chronic pancreatitis K86.0; other chronic pancreatitis K86.1). Periods were defined as pre-epidemic (2018–2019) and epidemic (2020–2021). Aggregate hospital and gastroenterology department admissions were summarized, and differences between periods were compared with statistical testing (P < .05 considered significant). Ethical principles (Declaration of Helsinki) and STROBE reporting guidelines were noted.

• Overall hospital admissions: 135,494 (2018–2019) vs 121,055 (2020–2021). Gastroenterology department admissions: 4,103 (pre-epidemic) vs 4,256 (epidemic). Rate per 1000 admissions to gastroenterology increased by 5.48% during the epidemic period compared with pre-epidemic. • Total ALD or pancreatitis admissions identified: 849 (January 2018–December 2021). Pre-epidemic: 388; epidemic: 461 (+15.8%). • ALD admissions: 168 (pre) vs 224 (epidemic); P = .003 (significant increase). • Alcoholic acute pancreatitis (K85.2): 182 (pre) vs 202 (epidemic); P = .32 (not significant). • Acute pancreatitis (other etiologies): 907 (pre) vs 859 (epidemic); P = .34 (not significant). • Alcohol-induced chronic pancreatitis (K86.0): 38 (pre) vs 35 (epidemic); P = .77 (not significant). • Chronic pancreatitis (other, K86.1): 109 (pre) vs 76 (epidemic); P = .026 (significant decrease). • In-hospital mortality: 19 (pre) vs 22 (epidemic). • 30-day readmission: 99 (pre) vs 86 (epidemic).

Findings align with global reports indicating increased alcohol misuse during the pandemic. The significant rise in ALD admissions suggests heightened alcohol-related harm in Western Sydney during COVID-19. Proposed contributors include social isolation, stress, unemployment, changes in habits, potential delays in seeking care due to fear of COVID-19, disruptions to healthcare services (redeployment of staff and reduced face-to-face appointments), and potentially fewer comprehensive etiologic evaluations leading to broader ALD diagnoses. Acute pancreatitis, which typically requires hospitalization, serves as a marker of alcohol misuse but did not significantly increase in alcoholic acute cases.

The COVID-19 pandemic and governmental restrictions were associated with increased admissions for alcohol-related liver disease in Western Sydney, indicating unintended societal health consequences. Public health strategies should prioritize reducing heavy alcohol consumption through primary care-based counseling for high-risk groups, regulation of alcohol promotion, and development of targeted post-pandemic policies. Long-term impacts remain uncertain and warrant ongoing monitoring.

The dataset links alcohol consumption and clinical outcomes (ALD or pancreatitis) only indirectly and cannot establish causal relationships. Clinical data were limited to admission records, lacking detailed medical histories and long-term outcomes. Psychosocial and environmental factors that influence drinking behaviors were not captured.