Impact of the COVID-19 Pandemic on Chronic Liver Disease and Cirrhosis Mortality in the United States: A Divergent Trend Analysis by Underlying Etiology (2018-2024).
7 affiliations
- 1General Practice, Ceda Orthopedic Group, Miami, USA.
- 2Clinical Research, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.
- 3Primary Care, Hermes Medical Group, Miami, USA.
- 4Internal Medicine, Mount Sinai Medical Center, Hialeah, USA.
- 5General Practice, American Medical Association, Hialeah, USA.
- 6Urology, Mission City Urology, San Antonio, USA.
- 7Research and Development, Tricocenter Miami, Miami Lakes, USA.
Abstract
Background
Chronic liver disease (CLD) and cirrhosis are major causes of mortality in the United States, with substantial variation by etiology, demographics, and geography. Alcohol-related liver disease (ALD) mortality increased before the COVID-19 pandemic and accelerated during its early phase. Whether alcohol-related and non-alcohol-related CLD and cirrhosis followed divergent mortality trajectories during and after the pandemic remains incompletely characterized.Methods
We conducted a population-based mortality study using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) National Vital Statistics System data for deaths occurring from 2018 to 2024. Deaths were classified as ALD (K70) or CLD and cirrhosis not coded as alcohol-related (K73-K74). Periods were defined as pre-pandemic (2018-2019), pandemic (2020-2021), and post-acute pandemic (2022-2024). Outcomes included mortality counts, age-adjusted mortality rates, percentage changes, and years of potential life lost before age 75 (YPLL-75). All data aggregation, rate calculations, and statistical analyses, including confidence interval derivations, were performed using Python Version 3.10 (Python Software Foundation, Wilmington, Delaware, United States), utilizing the pandas and NumPy libraries. Analyses were stratified by sex, race and ethnicity, urbanization, and state.Results
K70 deaths increased from 47,277 pre-pandemic to 62,601 during 2020-2021 (+32.4%), compared with an increase in K73-K74 deaths from 39,895 to 45,613 (+14.3%). During 2022-2024, K70 accounted for 87,294 deaths versus 71,982 for K73-K74. Average annual YPLL-75 increased by 38.8% for K70 compared with 19.5% for K73-K74, with YPLL per death consistently higher for K70. Marked disparities were observed by sex, race, urbanization, and state. American Indian or Alaska Native populations had the highest K70 mortality rates and largest pandemic-era increase, while nonmetropolitan populations experienced greater increases than metropolitan populations.Conclusions
Alcohol-related and non-alcohol-related CLD and cirrhosis demonstrated distinct mortality trajectories during the pandemic era, with ALD contributing to a disproportionate burden of premature mortality. These findings describe temporal and etiologic differences in mortality and may inform targeted prevention and treatment strategies, although the observational design does not permit causal attribution to specific pandemic-related mechanisms.
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BibTeX
@article{espinosa2026impact,
title = {{Impact of the COVID-19 Pandemic on Chronic Liver Disease and Cirrhosis Mortality in the United States: A Divergent Trend Analysis by Underlying Etiology (2018-2024).}},
author = {Elizabeth Blanco Espinosa and Yusvell Mori Gonzalez and Leandro Patterson and Javier A Mendoza and Wendy Larrondo Del Campo and Gabriela Sanchez and Francisco Sotolongo Castro and Yurisleydis Dominguez and Juan T Vargas Rivera and Aitor J Roche Perez and Carlos Acosta-Batista},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116773},
url = {https://europepmc.org/article/MED/42921491},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of the COVID-19 Pandemic on Chronic Liver Disease and Cirrhosis Mortality in the United States: A Divergent Trend Analysis by Underlying Etiology (2018-2024).
AU - Elizabeth Blanco Espinosa
AU - Yusvell Mori Gonzalez
AU - Leandro Patterson
AU - Javier A Mendoza
AU - Wendy Larrondo Del Campo
AU - Gabriela Sanchez
AU - Francisco Sotolongo Castro
AU - Yurisleydis Dominguez
AU - Juan T Vargas Rivera
AU - Aitor J Roche Perez
AU - Carlos Acosta-Batista
PY - 2026
DA - 2026/09/23
JO - Cureus
DO - 10.7759/cureus.116773
UR - https://europepmc.org/article/MED/42921491
AB - Background Chronic liver disease (CLD) and cirrhosis are major causes of mortality in the United States, with substantial variation by etiology, demographics, and geography. Alcohol-related liver disease (ALD) mortality increased before the COVID-19 pandemic and accelerated during its early phase. Whether alcohol-related and non-alcohol-related CLD and cirrhosis followed divergent mortality trajectories during and after the pandemic remains incompletely characterized.Methods We conducted a population-based mortality study using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) National Vital Statistics System data for deaths occurring from 2018 to 2024. Deaths were classified as ALD (K70) or CLD and cirrhosis not coded as alcohol-related (K73-K74). Periods were defined as pre-pandemic (2018-2019), pandemic (2020-2021), and post-acute pandemic (2022-2024). Outcomes included mortality counts, age-adjusted mortality rates, percentage changes, and years of potential life lost before age 75 (YPLL-75). All data aggregation, rate calculations, and statistical analyses, including confidence interval derivations, were performed using Python Version 3.10 (Python Software Foundation, Wilmington, Delaware, United States), utilizing the pandas and NumPy libraries. Analyses were stratified by sex, race and ethnicity, urbanization, and state.Results K70 deaths increased from 47,277 pre-pandemic to 62,601 during 2020-2021 (+32.4%), compared with an increase in K73-K74 deaths from 39,895 to 45,613 (+14.3%). During 2022-2024, K70 accounted for 87,294 deaths versus 71,982 for K73-K74. Average annual YPLL-75 increased by 38.8% for K70 compared with 19.5% for K73-K74, with YPLL per death consistently higher for K70. Marked disparities were observed by sex, race, urbanization, and state. American Indian or Alaska Native populations had the highest K70 mortality rates and largest pandemic-era increase, while nonmetropolitan populations experienced greater increases than metropolitan populations.Conclusions Alcohol-related and non-alcohol-related CLD and cirrhosis demonstrated distinct mortality trajectories during the pandemic era, with ALD contributing to a disproportionate burden of premature mortality. These findings describe temporal and etiologic differences in mortality and may inform targeted prevention and treatment strategies, although the observational design does not permit causal attribution to specific pandemic-related mechanisms.
SN - 2168-8184
ER -