Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts.
Now with Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA Health Forum. 2024 Apr 5;5(4):e240501. doi: 10.1001/jamahealthforum.2024.0501.
Research has demonstrated an association between the COVID-19 pandemic and increased alcohol-related liver disease hospitalizations and deaths. However, trends in alcohol-related complications more broadly are unclear, especially among subgroups disproportionately affected by alcohol use.
To assess trends in people with high-acuity alcohol-related complications admitted to the emergency department, observation unit, or hospital during the COVID-19 pandemic, focusing on demographic differences.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal interrupted time series cohort study analyzed US national insurance claims data using Optum's deidentified Clinformatics Data Mart database from March 2017 to September 2021, before and after the March 2020 COVID-19 pandemic onset. A rolling cohort of people 15 years and older who had at least 6 months of continuous commercial or Medicare Advantage coverage were included. Subgroups of interest included males and females stratified by age group. Data were analyzed from April 2023 to January 2024.
COVID-19 pandemic environment from March 2020 to September 2021.
Differences between monthly rates vs predicted rates of high-acuity alcohol-related complication episodes, determined using claims-based algorithms and alcohol-specific diagnosis codes. The secondary outcome was the subset of complication episodes due to alcohol-related liver disease.
Rates of high-acuity alcohol-related complications were statistically higher than expected in 4 of 18 pandemic months after March 2020 (range of absolute and relative increases: 0.4-0.8 episodes per 100 000 people and 8.3%-19.4%, respectively). Women aged 40 to 64 years experienced statistically significant increases in 10 of 18 pandemic months (range of absolute and relative increases: 1.3-2.1 episodes per 100 000 people and 33.3%-56.0%, respectively). In this same population, rates of complication episodes due to alcohol-related liver disease increased above expected in 16 of 18 pandemic months (range of absolute and relative increases: 0.8-2.1 episodes per 100 000 people and 34.1%-94.7%, respectively).
In this cohort study of a national, commercially insured population, high-acuity alcohol-related complication episodes increased beyond what was expected in 4 of 18 COVID-19 pandemic months. Women aged 40 to 64 years experienced 33.3% to 56.0% increases in complication episodes in 10 of 18 pandemic months, a pattern associated with large and sustained increases in high-acuity alcohol-related liver disease complications. Findings underscore the need for increased attention to alcohol use disorder risk factors, alcohol use patterns, alcohol-related health effects, and alcohol regulations and policies, especially among women aged 40 to 64 years.
研究表明，COVID-19 大流行与酒精性肝病住院和死亡人数增加之间存在关联。然而，更广泛的酒精相关并发症的趋势尚不清楚，尤其是在受酒精使用影响较大的亚组中。
评估 COVID-19 大流行期间，因高急症酒精相关并发症而入住急诊科、观察病房或医院的人群的趋势，重点关注人口统计学差异。
设计、地点和参与者：本纵向中断时间序列队列研究使用 Optum 的匿名 Clinformatics Data Mart 数据库，分析了美国全国保险索赔数据，该数据库来自 2017 年 3 月至 2021 年 9 月，包括 COVID-19 大流行前和大流行后的时期。纳入了至少有 6 个月连续商业或医疗保险优势覆盖的 15 岁及以上的滚动队列人群。感兴趣的亚组包括按年龄组分层的男性和女性。数据分析于 2023 年 4 月至 2024 年 1 月进行。
2020 年 3 月至 2021 年 9 月的 COVID-19 大流行环境。
使用基于索赔的算法和酒精特异性诊断代码确定的高急症酒精相关并发症发作的每月实际发生率与预期发生率之间的差异。次要结局是因酒精性肝病引起的并发症发作亚组。
在 2020 年 3 月之后的 18 个大流行月中的 4 个月中，高急症酒精相关并发症的发生率高于预期（绝对和相对增加幅度分别为：0.4-0.8 例/每 10 万人和 8.3%-19.4%）。40 岁至 64 岁的女性在 18 个大流行月中的 10 个月中经历了统计学上显著的增加（绝对和相对增加幅度分别为：1.3-2.1 例/每 10 万人和 33.3%-56.0%）。在同一人群中，因酒精性肝病引起的并发症发作的发生率在 18 个大流行月中有 16 个高于预期（绝对和相对增加幅度分别为：0.8-2.1 例/每 10 万人和 34.1%-94.7%）。
在这项针对全国商业保险人群的队列研究中，COVID-19 大流行期间有 4 个月的高急症酒精相关并发症发作超出预期。40 岁至 64 岁的女性在 18 个大流行月中的 10 个月中经历了 33.3%至 56.0%的并发症发作增加，这与高急症酒精相关肝病并发症的大幅和持续增加有关。这些发现强调需要更加关注酒精使用障碍的危险因素、酒精使用模式、酒精相关的健康影响以及酒精法规和政策，尤其是 40 岁至 64 岁的女性。
