Fedeli U, Barbiellini Amidei C, Casotto V, Grande E, Saia M, Zanetto A, Russo FP. Mortality from chronic liver disease: Recent trends and impact of the COVID-19 pandemic. World J Gastroenterol 2023; 29(26): 4166-4173 [PMID: 37475843 DOI: 10.3748/wjg.v29.i26.4166]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Alberto Zanetto, Francesco Paolo Russo, Department of Surgery Oncology and Gastroenterology, University of Padua, Padova 35128, Italy
Alberto Zanetto, Francesco Paolo Russo, Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, Padova 25128, Italy
Author contributions: Fedeli U designed the outline, coordinated the writing of the paper, prepared figures/tables; Barbiellini Amidei C, Casotto V, Grande E, Saia M, Zanetto A, and Russo FP collected the relevant bibliography and wrote the sections of the review; Barbiellini Amidei C and Casotto V contributed to “trends before the pandemic”; Zanetto A and Russo FP contributed to “COVID-19 and CLD”; Grande E and Saia M contributed to “CLD as a cause of deaths during the pandemic”; and all authors contributed to revising the first draft and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: April 14, 2023 Peer-review started: April 14, 2023 First decision: May 23, 2023 Revised: May 26, 2023 Accepted: June 12, 2023 Article in press: June 12, 2023 Published online: July 14, 2023
Abstract
Prepandemic time trends in mortality from chronic liver disease (CLD) differed according to specific cause of death (decreasing for liver cirrhosis, stable or increasing for liver cancer), etiology (increasing for nonalcoholic fatty liver disease, generally decreasing for other etiologies), and world region (decreasing in areas with the highest burden of hepatitis B virus, increasing in Eastern Europe and other countries). The coronavirus disease 2019 (COVID-19) pandemic affected mortality of patients with CLD both directly, with a higher risk for severe illness and death depending on age, stage and etiology of the disease, and indirectly, through social isolation and loss of support, harmful drinking, and difficulties in access to care. Nevertheless, only sparse data are available on variations in CLD as a cause of death during the pandemic. In the USA, in 2020-2021 a growth in mortality was registered for all liver diseases, more marked for alcoholic liver disease, especially among young people aged 25-44 years and in selected ethnic groups. COVID-19 related deaths accounted only for a minor part of the excess. Further data from mortality registers of other countries are warranted, preferably adopting the so-called multiple cause-of-death approach, and extended to deaths attributed to viral hepatitis and liver cancer.
Core tip: Preliminary data on causes of death during the coronavirus disease 2019 pandemic suggest that mortality from chronic liver disease (CLD) increased especially in countries where the alcoholic etiology was predominant, or with a prepandemic growing trend in mortality from alcoholic liver disease. Population-based studies on the direct and indirect effects of the pandemic on CLD mortality are strongly warranted. Analyses adopting the multiple cause-of-death approach might be better suited to fully investigate the impact of the pandemic on complex long-term pre-existing trends.
