Excess Deaths of Gastrointestinal, Liver, and Pancreatic Diseases During the COVID-19 Pandemic in the United States

Abstract

Objectives: To evaluate excess deaths of gastrointestinal, liver, and pancreatic diseases in the United States during the COVID-19 pandemic. Methods: We retrieved weekly death counts from National Vital Statistics System and fitted them with a quasi-Poisson regression model. Cause-specific excess deaths were calculated by the difference between observed and expected deaths with adjustment for temporal trend and seasonality. Demographic disparities and temporal-spatial patterns were evaluated for different diseases. Results: From March 2020 to September 2022, the increased mortality (measured by excess risks) for Clostridium difficile colitis, gastrointestinal hemorrhage, and acute pancreatitis were 35.9%; 24.8%; and 20.6% higher than the expected. For alcoholic liver disease, fibrosis/cirrhosis, and hepatic failure, the excess risks were 1.4-2.8 times higher among younger inhabitants than older inhabitants. The excess deaths of selected diseases were persistently observed across multiple epidemic waves with fluctuating trends for gastrointestinal hemorrhage and fibrosis/cirrhosis and an increasing trend for C. difficile colitis. Conclusion: The persistently observed excess deaths of digestive diseases highlights the importance for healthcare authorities to develop sustainable strategies in response to the long-term circulating of SARS-CoV-2 in the community.

Keywords: COVID-19; GI hemorrhage; disparity; excess mortality; liver disorder.

FIGURE 1

Weekly estimates of excess deaths associated with selected gastrointestinal, liver, and pancreatic diseases (United States, March 2020 to September 2022). This figure shows the time-series estimates of excess death counts associated with selected gastrointestinal, liver, and pancreatic diseases from March 2020 to September 2022. The contributing cause of death was adopted. The subtypes included: GI hemorrhage (not otherwise specified), ulcers, Clostridium difficile colitis, colorectal cancer, alcoholic liver disease, chronic hepatitis C, hepatic fibrosis/cirrhosis, hepatic failure, and acute pancreatitis. Waves were identified according to the weekly surveillance of COVID-19 deaths in the United States. Wave I was from March 2020 to June 2020, Wave II was from June 2020 to October 2020, Wave III was from October 2020 to June 2021, Wave IV was from June 2021 to November 2021, Wave V was from November 2021 to May 2022 and Wave VI was from May 2022 to September 2022.

FIGURE 2

Temporal and spatial excess risks (%) associated with gastrointestinal hemorrhage (United States, March 2020 to September 2022). (A) temporal variated excess risks stratified by region; (B) temporal variated excess risks stratified by state, where the 4-week moving average was operated for each time series; (C) overall estimates by states (states with negative estimated values were not shown). The contributing cause of death was adopted. The six COVID-19 death waves were defined as Wave I (March 2020 to June 2020), Wave II (June 2020 to October 2020), Wave III (October 2020 to June 2021), Wave IV (June 2021 to November 2021), Wave V (November 2021 to May 2022), and Wave VI (May 2022 to September 2022).

FIGURE 3

Temporal and spatial excess risks (%) associated with alcoholic liver disease (United States, March 2020 to September 2022). (A) temporal variated excess risks stratified by region; (B) temporal variated excess risks stratified by state, where the 4-week moving average was operated for each time series; (C) overall estimates by states (states with negative estimated values were not shown). The contributing cause of death was adopted. The six COVID-19 death waves were defined as Wave I (March 2020 to June 2020), Wave II (June 2020 to October 2020), Wave III (October 2020 to June 2021), Wave IV (June 2021 to November 2021), Wave V (November 2021 to May 2022), and Wave VI (May 2022 to September 2022).