Increases in binge and heavy drinking frequencies during the COVID-19 pandemic are associated with liver fibrosis

Aims We aim to investigate alcohol consumption patterns before and after the pandemic onset and utilize liver fibrosis measurements to identify at-risk drinking patterns. Methods We selected 10 259 participants in the National Health and Nutrition Examination Survey across two cohorts: January 2017–March 2020 (pre-pandemic) and August 2021–August 2023 (during-pandemic). We employed the alcohol use questionnaire to identify drinking patterns, including heavy drinking and binge drinking frequencies. Vibration-controlled transient elastography was used to define stage 1 and significant liver fibrosis by liver stiffness measurement >7 to 9 and > 9 kPa, respectively. We first compared the prevalence and frequencies of binge drinking and single day heavy drinking between the two cohorts. We then calculated the odds of liver fibrosis among during-pandemic participants with various alcohol use patterns, compared to pre-pandemic participants with the same use patterns. Results We found a higher prevalence of at-risk alcohol use in the during-pandemic cohort, including single-day heavy drinking and binge drinking at least once a month. Notably, the distributions of the frequency of single day heavy drinking and binge drinking were skewed towards a higher frequency of at-risk alcohol use in the during-pandemic group. Furthermore, the odds of significant liver fibrosis were higher among during-pandemic non-heavy/binge drinkers and heavy/binge drinkers, compared to their pre-pandemic counterparts. Conclusions The data showed increases in heavy drinking and binge drinking in the during-pandemic cohort, which calls for urgent public health interventions to mitigate future adverse health impacts.