Alcohol-Related Deaths Increased in Canada During Pandemic

After the onset of the COVID-19 pandemic, alcohol use increased sharply in Canada, ultimately leading to a 24% jump in alcohol-related deaths and a 14% rise in alcohol-related hospitalizations during the first 2 years alone, according to new research.

The sobering data align with findings in other countries, including a 29% increase in alcohol-related deaths in the United States and an 18% increase in deaths across Europe.

“Since the onset of the COVID-19 pandemic in March 2020, population alcohol consumption and problem drinking have surged sharply,” lead author Yipu Shi, MB, PhD, a senior epidemiologist at the Centre for Surveillance and Applied Research at the Public Health Agency of Canada in Ottawa, Ontario, Canada, told Medscape Medical News.

“The rise in alcohol consumption observed early in the pandemic was projected to have immediate and sustained effects on alcohol-related harm,” she said. “These findings serve as important lessons learned from the pandemic and will help inform public health strategies to reduce harm in future health emergencies.”

The study was published online on February 3 in CMAJ.

Analyzing Alcohol-Related Outcomes

Even before the pandemic, alcohol consumption was a leading cause of mortality and morbidity in Canada, particularly among patients aged 15-49 years, Shi said. Alcohol contributed to 18,000 deaths and 105,000 hospitalizations in 2017.

In 2020, retail alcohol sales volume increased by 2.1%, compared with the year before, marking the largest increase in more than a decade. This observation indicates a population-level increase in alcohol consumption, Shi said. During that same time, 26% of Canadian adults reported increased alcohol consumption, and 18% reported heavy drinking, which was defined as at least five drinks for men and at least four drinks for women during a single occasion.

To understand the effects of increased alcohol consumption, the researchers analyzed monthly hospitalization and mortality rates from the Canadian Vital Statistics and Discharge Abstract databases for 2016-2022, comparing pre-pandemic and pandemic periods. They estimated excess rates by comparing observed rates with expected rates, accounting for trends, seasonality, autocorrelation, and pandemic waves.

Alcohol-related deaths increased by 17.6% between April 2020 and December 2022, with a higher increase of 24% in 2020 and 2021. These increases led to 1596 excess deaths during the 3-year period.

In addition, alcohol-related hospitalizations increased by 8.1% during that time, with a 14% increase in 2020 and 2021. This finding equaled 7142 excess hospitalizations. Seasonal patterns emerged, with more hospitalizations during the summer than in the winter.

By region, alcohol-related deaths increased more in the Prairie provinces — Alberta, Manitoba, and Saskatchewan (28.1%) — and British Columbia (24.2%), where excess deaths were three times higher than in Ontario and the Atlantic provinces and more than six times higher than in Quebec.

Alcohol-related hospitalizations were also higher in the Prairie provinces (14.6%) and especially in the Northwest Territories, Nunavut, and Yukon (27.3%).

Younger adults had the highest increases in excess deaths (among those aged 25-44 years) and excess hospitalizations (among those aged 15-44 years). Mortality rose by 55.4% in those aged 25-44 years, 19.1% in those aged 45-64 years, and 2.6% in those aged 65 years or older.

Excess deaths increased at similar rates among men (17%) and women (17.8%). However, excess hospitalizations were almost three times higher in women (15.6%) than in men (5.7%), which should serve as an early warning sign for future liver-related disease and potentially concerning outcomes, the authors wrote.

Ultimately, excess hospitalizations and deaths were attributable to alcoholic liver disease (ALD) and alcohol use disorder (AUD). ALD was the leading cause of excess mortality, which increased by 22%, and of excess hospitalizations, which increased by 23%.

“Our findings highlight the importance of timely interventions to prevent high-risk drinking from developing into AUD or ALD, both of which demonstrated rising trends before the pandemic and continued at increasing rates during the pandemic,” Shi said. “Addressing alcohol-related harms may require a multifaceted approach involving public health interventions, alcohol policy and regulation, and appropriate health services.”

Offering Patient Resources

Shi recommended public health education to increase awareness of the risks for unhealthy alcohol use and promote stress management without alcohol. Increased alcohol consumption during the pandemic was likely driven by stress, boredom, declining mental health, and other factors related to well-being, she said.

“Alcohol use was already a major health and societal burden before the pandemic. While harms have returned to baseline, this study is a crucial reminder that much more needs to be done, both from a policy and healthcare perspective, to reduce alcohol-related harms,” said Daniel Myran, MD, associate scientist at the Ottawa Hospital Research Institute and assistant professor of family medicine at the University of Ottawa, both in Ottawa, Ontario, Canada. Myran, who wasn’t involved with this study, has researched changes in health service use due to alcohol during the pandemic.

“Research has consistently shown major gaps in care for individuals with AUD, with most patients not receiving evidence-based treatments such as medically managed withdrawal or anticraving medications,” he said. “Healthcare providers should routinely screen alcohol use and offer treatment or referrals based on their expertise. Individuals with heavy but not disordered drinking may also benefit from brief counseling about the adverse health effects of alcohol use.”

The Canadian Alcohol Use Disorder Guideline Committee also published a guideline in 2023 for the clinical management of high-risk drinking and AUD. The document provides an evidence-based framework for detecting and addressing unmet treatment and care needs, Shi said.

“All of these deaths are 100% preventable, and hundreds of deaths and hospitalizations could have been prevented in these 2 years alone if alcohol had not been given the status of an essential good and if alcohol control policies had not been loosened, such as by allowing more home deliveries and widening [alcohol] availability outside of lockdowns,” said Jürgen Rehm, PhD, a senior scientist at the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. Rehm, who wasn’t involved with this study, co-authored the 2023 clinical guideline.

“Alcohol control policies should have been adapted, but also healthcare providers should have been better prepared for more service demand,” he said. “Clearly, response to the pandemic was the priority of the healthcare system, but cost-effective virtual addiction services could have been offered more quickly.”

The authors reported that no funding was received for the research. Shi, Myran, and Rehm reported having no relevant financial disclosures.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.