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

The COVID-19 pandemic, beginning in late 2019, led to widespread public health measures globally, including lockdowns and social restrictions. These measures, particularly stringent in low socioeconomic areas like Western Sydney, Australia, had a significant impact on population health. Increased anxiety, stress, and social isolation were widely reported, potentially leading to increased alcohol consumption and adverse health outcomes. Evidence from other countries demonstrated a rise in alcohol-related deaths and hospitalizations during the pandemic. This study aimed to determine if the COVID-19 pandemic and associated lockdowns in Western Sydney were associated with changes in hospital admissions for ALD and pancreatitis, two conditions strongly linked to alcohol misuse. Understanding this association is crucial for developing effective public health strategies to mitigate the long-term health consequences of the pandemic.

Several studies from around the world reported increased alcohol consumption and related problems during the COVID-19 pandemic. In the UK, alcohol-specific deaths rose by 18.6% in 2020 compared to 2019. In British Columbia, Canada, alcohol consumption reached a two-decade high during the first year of the pandemic, and hospitalizations for ALD in Alberta nearly doubled. Similarly, Japan saw an increase in hospital admissions for ALD and acute pancreatitis during the pandemic. In Australia, surveys revealed a significant increase in alcohol consumption among parents during the initial stages of the pandemic. This existing literature highlighted a global trend of increased alcohol-related harm during the pandemic, providing a context for investigating the specific impact in Western Sydney.

This retrospective cohort study utilized data from four public hospitals in Western Sydney: Auburn Hospital, Blacktown Hospital, Mount Druitt Hospital, and Westmead Hospital. The data encompassed medical record numbers, demographic data (age, gender, ethnicity), admission/discharge status, cause of admission, and primary diagnosis. Patients aged 18 years or older hospitalized between January 1, 2018, and December 31, 2021, were included. The study focused on admissions with primary diagnoses of ALD or pancreatitis. The period from January 25, 2020 (first COVID-19 case in NSW) to December 2021 (when most restrictions were lifted) was defined as the 'epidemic period,' and 2018-2019 was the 'pre-epidemic period'. Descriptive statistics and chi-square tests were used to compare admission rates and characteristics between the two periods. A p-value <0.05 was considered statistically significant.

A total of 849 ALD or pancreatitis admissions were identified between 2018 and 2021. The total number of admissions to gastroenterology departments was slightly higher during the epidemic period (4256) compared to the pre-epidemic period (4103), representing a 5.48% increase per 1000 admissions. Notably, a significant increase in ALD admissions was observed during the epidemic period (224 vs. 168, p=0.003), representing a 15.8% increase in ALD and pancreatitis admissions overall (388 to 461). While there was a small increase in acute pancreatitis admissions (182 to 202), this difference was not statistically significant (p=0.32). However, there was a statistically significant decrease in chronic pancreatitis admissions (38 vs 35 p=0.77) and other chronic pancreatitis admissions (109 to 76 p=0.026) during the epidemic period. In-hospital mortality rates showed a slight increase during the pandemic (19 to 22), and 30-day readmission rates decreased from 99 to 86.

The findings suggest a potential link between the COVID-19 pandemic and increased hospital admissions for ALD in Western Sydney. The significant rise in ALD admissions, coupled with a less pronounced but still noticeable increase in acute pancreatitis admissions, aligns with evidence of increased alcohol consumption during lockdowns. The observed increase in ALD may be attributed to several factors: increased alcohol consumption, delayed presentations due to fear of hospital visits, disruption of healthcare services, and potential challenges in accurate diagnosis during the pandemic. Acute pancreatitis, due to its always requiring hospitalization, serves as a more reliable marker of alcohol misuse during this time. The decrease in chronic pancreatitis admissions may reflect challenges to accessing routine care during this time.

This study demonstrates a potential association between the COVID-19 pandemic and increased hospital admissions for ALD in Western Sydney. The findings highlight the unintended societal consequences of pandemic-related restrictions. Future research should investigate the long-term impacts of the pandemic on alcohol-related health outcomes and explore strategies to mitigate alcohol misuse, such as primary care-based counseling, regulation of alcohol promotion, and development of specific post-pandemic policies.

The study's limitations include a focus on hospital admissions without detailed individual alcohol consumption data or comprehensive patient medical histories. Psychosocial and environmental factors influencing drinking habits were not incorporated into the analysis. The study's reliance on primary diagnoses might have led to underestimation of alcohol-related pancreatitis cases, and the retrospective nature of the study limits causal inferences.