Over the course of the Covid-19 pandemic, the drinking habits and attitudes of many were altered, leading to a rise in alcohol consumption in several countries. Those who were already heavy drinkers were impacted more severely, and in consequence, the risk of developing alcohol-associated liver disease (ALD) increased for many people, contributing to the projected global disease burden. GlobalData epidemiologists forecast that by the end of 2024, there will be 90,000 total prevalent cases of liver cirrhosis—the end stage of ALD—in men and women, aged 20 years and older, in Brazil. GlobalData also forecasts that number to increase to 95,000 cases by the end of 2029.
The change in the pattern of alcohol consumption, healthcare system disruptions, and alcohol services and treatments all had an effect on the epidemiology of ALD post-pandemic. In a study published in Annals of Hepatology in December 2024, Heringer and colleagues investigated how ALD-related hospitalisations changed after the pandemic in four different ethnic groups in Brazil, and the findings highlighted underlying health inequities. This research analysed ALD-related hospital admissions on all inpatient data for any hospital stays at a public hospital. The database extracted data from approximately 2,300 hospitals in five regions of Brazil, across 26 states and one federal district. The observation period was from May 2017 to December 2022. ALD-related hospitalisations were categorised by race into four groups: black, pardo, black and pardo combined, and others. Pardo is a term used to encompass Brazilians of mixed ethnicities and heritage, and Others include white and unknown ethnicities. A total of 84,787 ALD-related hospitalisations were recorded over 34 consecutive months.
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The results of the study showed that the mean age of patients was 53 years, 83.6% of the inpatients were men, and 38% were pardo. From March 2020, which marked the start of the pandemic, there was a statistically significant drop in ALD-related hospitalisations for all race groups except for the black population, which saw a statistically non-significant drop in hospitalisations, for the next three consecutive months. After this immediate decrease in ALD-related hospitalisations, there was a surge in hospitalisations that was statistically significant for the total population, the pardo population, and the black population. There was a disproportionate increase in monthly ALD-related hospitalisation rates in the pardo group. The in-hospital mortality was highest in the black population (19.49%), followed by the pardo population (18.80%) and the others population (17.30%).
Brazil implemented alcohol policies that led to a reduction in ALD rates pre-Covid-19. However, after the pandemic, the rates of ALD rose after an initial dip in hospitalisation rates, which was highest in the pardo population. This illustrates the underlying health inequities that may have potentially led to the increased cases of ALD-related hospitalisations in the racial minority groups and the high in-hospital mortality rates in the black population. These results emphasise the need to address social determinants of health that lead to poorer health in minorities in Brazil.
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By GlobalData