Far more people have died from liver disease and diabetes in England and Wales since the coronavirus pandemic began than expected. Exactly why is unclear, but some deaths may be due to difficulties in accessing healthcare during periods of lockdown, along with rising alcohol consumption.
Between March 2020 and June 2022, there were 3834 excess deaths caused by cirrhosis and other liver diseases in England and Wales compared with the rolling five-year averages for these conditions, (ONS). This is a 19.7 per cent rise on expected levels. Meanwhile, in the same period, there were 3466 excess deaths caused by diabetes – a 24.4 per cent rise.
The five-year averages exclude 2020 to discount the high mortality figures seen at the height of the pandemic, and the ONS only looked at the primary cause of death, so no deaths were counted twice.
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“We know the vast majority of deaths due to liver disease result from alcohol-related liver disease,” says at the University of Leeds in the UK. “There was an increase in alcohol consumption in previously already heavy drinkers during the pandemic. It is very likely that this increased consumption has led to the increase in liver disease deaths seen over that period.”
Deaths from liver disease between March 2020 and June 2022 rose higher above the five‑year averages in women than in men – by 22.4 per cent compared with 18 per cent – although the cause isn’t entirely clear. “It may be related to impacts of the pandemic that disproportionately affected women, but really we don’t know,” says Rowe. .
at Harvard University says similar trends were seen in the US, with . “It’s not just the lockdowns that caused an increase in alcohol consumption, the lingering elevated stress in society is contributing to sustained increase in alcohol,” he says. “Even a short-term increase in alcohol can result in chronic liver disease and associated mortality.”
The pandemic may have also led to later diagnoses of liver diseases, says at the University of Nottingham, UK.
“We know that cirrhosis is often diagnosed late – almost 50 per cent of cases are first detected following an emergency presentation with end-stage cirrhosis, when survival is poor,” she says. “If there is a true increase in the number of deaths during the pandemic period, it could relate to delays in diagnosis and late presentations related to reduced access to services.”
Explanations for the excess diabetes deaths are less clear, says at Monash University in Melbourne, Australia. One issue is that these deaths may be recorded differently depending on the doctor.
“For example, people with diabetes are known to be at increased risk of death from cardiovascular disease, but whether or not the doctor completing the death certificate for a person with diabetes who died of a heart attack actually attributes the death to diabetes is quite variable,” says Shaw.
But he notes that the use of lockdowns is likely to have played a part. “This might be expected to adversely affect treatment of diabetes, so it might not be a surprise to see a rise in deaths in people with diabetes,” he says.
In addition, Morling says that we don’t know how many of the deaths involving diabetes during the pandemic also involved covid‑19. “In the 50-plus group, it is likely to be related, as we know diabetes was a risk factor for covid‑19,” she says.
Some studies also suggest that covid-19 can sometimes cause diabetes. “But the evidence for this is still unclear, especially for type 1 diabetes,” says at the University of Exeter in the UK.
Ultimately, the higher diabetes deaths are likely to be due to a combination of several of these factors, says Morling.
“Since the pandemic, the number of diabetics receiving all eight recommended health checks is increasing, with the NHS investing £36 million to help tackle health inequalities,” says a spokesperson for the UK government’s Department of Health and Social Care. It has also opened more than 80 community diagnostic centres in order to increase tests for liver disease, says the spokesperson.
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