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Alcohol consumption increased substantially across the United States during the COVID-19 pandemic, but the impact was greatest among American Indian and Alaska Native (AIAN) populations, where deaths from alcohol-associated liver disease were six times those of white people, according to a study by Massachusetts General Hospital (MGH), a founding member of Mass General Brigham (MGB). The disproportionately high mortality rate reflects not just the pandemic, but a systemic failure of supportive health care and lack of critical resources for AIAN populations which demand urgent action by public policy leaders, the researchers reported in a study published in JAMA Health Forum.
“Even before the pandemic we saw a steady increase in alcohol consumption in this country, and continue to experience high levels of alcohol-associated liver disease exacerbated by COVID-19,” says senior author Jagpreet Chhatwal, Ph.D., associate professor of Radiology, Harvard Medical School and director of the Institute for Technology Assessment at MGH. “Our examination of all racial or ethnic groups showed that none are more vulnerable than American Indian and Alaska Native. While alcohol consumption is known to be lower among these groups compared to others, studies have shown that people who engage in any level of drinking are more likely to become excessive in their habit.”
Alcohol-associated liver disease (ALD) is characterized by progressive deterioration of the liver and loss of function, and is now the leading indication for liver transplant in the United States. The rate of ALD grew nationally by 43 percent from 2009 to 2015, accounting for more than $5 billion in direct healthcare costs in 2015 alone. At the height of the pandemic, deaths from ALD increased by 23 percent in just one year. Drawing on the CDC’s WONDER Multiple Cause of Death database, Mass General researchers learned that ALD mortality rose in nearly every state from 2019 to 2020, with the greatest mortality rates occurring in Wyoming, South Dakota and New Mexico—states with some of the highest concentrations of AIAN populations.
As for actionable measures, the study cites the need for significantly higher levels of preventive healthcare and resource allocation to agencies like the Indian Health Service (IHS), the U.S. Department of Health and Human Services agency charged with providing comprehensive health services to the approximately 2.6 million American Indians and Alaska Natives in 574 federally recognized tribes in 37 states.
“Based on our findings, strong action needs to be taken at the public policy level to increase awareness among American Indians and Alaska Natives of the alarming mortality rates from alcohol-associated liver disease, and to implement universal alcohol screening and preventive health programs,” says Neeti Kulkarni, a research analyst at the MGH Institute for Technology Assessment, and lead author of the study. “It’s critical for the states and federal government to recognize and responsibly address this problem before it spirals into a major health crisis for our country.”
Chhatwal points out that alcohol consumption hasn’t shown any signs of decline even as the pandemic has receded. “It’s no coincidence that in 2021, life expectancy in this country dropped to its lowest level since 1996, with ALD being the top reason after COVID-19 and unintentional injuries,” he says. “Alcohol-associated liver disease among all ethnicities continues to represent a serous burden on our nation’s healthcare system, and the problem will only intensify if we don’t take meaningful steps to address it now.”
Noah Brown, Massachusetts General Hospital