Deaths from GI, Liver and Pancreatic Diseases Increased in COVID-19 Pandemic

Death rates from gastrointestinal, liver and pancreatic diseases were found to have increased in the US during the COVID-19 pandemic, in an analysis which also revealed mortality rates from C dificile colitis steadily increased while rates from other conditions fluctuated over time and with "waves" of the pandemic.

"Previous evidence has indicated patients with digestive-related abnormalities were vulnerable to the pandemic, not only because of their higher mortality risk of COVID-19, but their unmet healthcare needs due to the overwhelmed healthcare services," indicated Lefei Han, PhD, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China, and colleagues.

"However few studies have quantified the impact of the pandemic on individuals with digestive diseases.There is also limited research examining the excess deaths associated with digestive diseases during the pandemic," they observed.

Han and colleagues accessed the National Vital Statistics System through the CDC's Wide-ranging Online Data for Epidemiologic Research (WONDER) database for deaths occurring in the US from January 2018 to November 2022. The investigators analyzed data in relation to six "waves" of COVID-19, and accounted for seasonal effects.

Cause of death indicated on death certificates corresponded to the ICD-10 classification of diseases. The investigators focused the study on the dominant causes of death related to the digestive system, including GI hemorrhage and obstruction, C dificile colitis, alcoholic liver disease and cancers. They determined excess risk (ER) from the difference between observed deaths in the pandemic period and the expected deaths from historical data.

Han and colleagues found the largest increase in death risk from GI diseases with C dificile colitis (ER 35.8%, 95% CI 34.1-37.8), followed by GI hemorrhage (ER 24.8%, 34.1-38.8) ulcers (ER 15.1%, 13.6-16.7) and colorectal cancer ((ER 3.4%, 2.9-3.9).For liver and pancreatic diseases, acute pancreatitis was the largest ER (20.6%, 18.9-22.4%), followed by alcoholic liver disease (ER 19.9%, 19.2-20.6).

Although the elderly accounted for more ER counts, the younger population was found to have higher ERs of GI diseases, particularly for GI hemorrhage (38.7% in adults aged 20-64 years vs 26.3% in adults aged 65-84 years), ulcers (23.4% vs 9.8%) and C dificile colitis (54.7% vs 39.6%).

The investigators speculate that the temporal fluctuation of excess deaths, particularly of GI hemorrhage, might reflect, to some degree, "the magnitude of overburdened health services for GI patients across multiple pandemic waves."

They contrast that pattern, however, with the persistently increasing trend for excess death related to C dificile colitis."During the SARS-CoV-2 infection, (some) patients may experience changed gut microbiota composition.Frequent prescription of antibiotics to treat or prevent infections complicated with COVID also allowed opportunistic pathogen colonization...," Han and colleagues suggest.

With regard to ER from liver diseases, Han and colleagues suggest that those with pre-existing chronic liver disease were at particular risk for poor outcomes during COVID due to immune dysregulation and coagulopathy."SARS-CoV-2 can provoke liver injury through systemic inflammation reaction, cytokine signaling, hypoxia ischemia-reperfusion, drug toxicity, and direct infection of hepatocytes," they noted.

The excess deaths during the pandemic certainly reflected multiple factors, the investigators acknowledged. ”The excess mortality estimates during the pandemic could be an integrated impact of changes in virus virulence, treatment modality, healthcare capacity, vaccination, infection control strategies, chronic disease management, and personal factors," Han and colleagues posited.