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The number of Alaskans with severe liver disease rose sharply during the COVID-19 pandemic to levels well above the national average, new state data shows.
The surge in liver-related hospitalizations, which was most pronounced among younger Alaskans, was due largely to heavy drinking, medical providers and substance abuse advocates here say.
With its isolation and long, dark winters, Alaska has long had higher-than-average rates of substance misuse and addiction. But the recent rise in liver disease among Alaskans appears to have been brought on by the pressure and upheaval associated with the pandemic.
"We have data that shows that Alaskans did definitely increase their alcohol usage during the pandemic," said Tiffany Hall, executive director of Recover Alaska, a local policy group that tries to address substance misuse in the state.
She cited a state health department study conducted during the first year of the pandemic in 2020 that showed an approximately 30% increase in household alcohol consumption due to stress linked to the pandemic.
"The second half of that sentence is really important because when people are drinking to cope with stress or to deal with trauma, that's much more dangerous drinking than if people are grabbing drinks to celebrate a promotion," Hall said. "Drinking to stress or to cope is more likely to lead to a substance use disorder."
Older Alaskans are typically more likely to suffer liver disease, which is often the result of long-term alcohol abuse. But in 2021, the rise was most pronounced among a younger age group — Alaskans in their 20s through 40s — across nearly every ethnic and racial group in the state, according to data from the state released earlier this month.
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Data showed a 91% jump in the number of Alaskans from 20 to 24 hospitalized for liver disease in 2021 compared to a 2017-2019 average, while Alaskans 50 to 64 years old only saw about a 50% increase during the same time frame, according to the Alaska Department of Health excess hospitalizations report.
The state report tracks how hospitalizations and emergency department visits from 2020 to 2021 compared to prior years. Researchers also found higher than usual rates of cardiovascular diseases, stroke and chronic respiratory disease.
One of the main risk factors for liver disease is frequent binge drinking. For men, the federal Centers for Disease Control and Prevention defines binge drinking as consuming five or more drinks in a short period of time and for women, four or more drinks in a short time.
Over time, frequent binge drinking can cause a buildup of fatty tissue and inflammation in the liver and eventually alcohol hepatitis and cirrhosis, or scarring of the liver, which can ultimately be fatal.
Many patients don't realize they have been binge drinking at a dangerous rate until they're extremely sick, according to Dr. Brian McMahon, clinical director of the Liver Disease and Hepatitis Program at the Alaska Native Medical Center in Anchorage.
"They think they don't have a problem because they only drink on weekends; or they go to work and don't drink during the day but come home and drink six or seven alcoholic drinks at night and a little more on the weekend," McMahon said. "And all of a sudden, without any warning, they get this acute hepatitis."
ANMC, ANTHC, Brian McMahon, doctor
Once someone has acute hepatitis, the mortality rate is about 30% within the next six months, he said.
Statewide, chronic liver disease and cirrhosis hospitalization rates increased significantly compared to the 2017 to 2019 average — a 28% increase in 2020, and a 58% increase in 2021.
Nationally, the rate of severe alcohol-related liver disease has been gradually on the rise since the early 2000s according to a study published in JAMA in 2019.
In Alaska, the rate of liver disease mortality rose by 400% over the last two decades — mostly in the last two years — compared to a 150% increase in the rest of the country.
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Another leading cause for the rise in liver disease in Alaska is hepatitis C, McMahon said. Chronic hepatitis C is a viral disease that can result in serious, sometimes life-threatening health problems like cirrhosis and liver cancer if left undetected and untreated.
It spreads through contact with blood from an infected person or, most commonly, by sharing needles or other equipment used to prepare and inject drugs, according to the CDC.
Most people who have hepatitis C won't have symptoms for years if ever. But half will develop a chronic form of the illness which can be much more serious.
People with chronic hepatitis C can often have no symptoms and don't feel sick. When symptoms appear, they often are a sign of advanced liver disease, the CDC says. The agency recommends that every adult get screened for hepatitis C at least once — it's free, and for adults not using injectable drugs where contaminated needles may be involved, one test is enough.
Alaska has also seen a similar rise in non-alcoholic fatty liver disease, in which the build-up of fatty tissue can lead to scarring and liver disease, a condition linked to health issues including diabetes, obesity and high blood pressure, according to McMahon.
Lifestyle changes to reduce cholesterol and improve heart health can also decrease risk for liver disease, he said.