Disentangling the 'COVID-19 alcohol paradox': reasons for changes in alcohol-specific disease burden during the COVID-19 pandemic in Germany

Background: During the COVID-19 pandemic, alcohol sales and average consumption have declined in many countries, while the number of people dying from alcohol-related diseases have increased. This phenomenon, dubbed as the COVID-19 alcohol paradox by some researchers, could be driven by changes in consumption and/or changes in health care access. In order to disentangle this paradox, we will use German data to a) quantify changes in alcohol-specific disease burden during the COVID-19 pandemic and b) examine whether changes in health care utilization and alcohol sales are linked to increases of alcohol-specific mortality.

Methods: We use hospital and mortality registry data from the years 2012 to 2020 to calculate age-standardized, monthly rates of alcohol-specific admissions and deaths. In order to evaluate whether changes in hospital admissions as well as beer and spirit sales are linked to increased death rates, we conduct time series analyses controlling for seasonal patterns as well as for trends in all-cause admissions and deaths. In additional analyses, we differentiate acute (F10.0, T51) from chronic harm (any other F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, Q86.0) based on ICD-10 diagnoses. Taxation-based sales data for beer and spirits from 2012 to 2020 be obtained on a monthly basis from the Federal Statistical Office. As there is no excise taxation for wine in Germany, monthly data points are not available.

Results: Annual data show an uptick of alcohol-related mortality in the year 2020 as compared to 2019 (+5.3%), the first increase for five years. Monthly data was not available at the time of writing the abstract but will be presented at Lisbon Addictions 2022.

Conclusion: This study will be one of the first to examine changes in both alcohol-specific morbidity and mortality during the COVID-19 pandemic. Thereby, the results are expected to help disentangling the COVID-19 alcohol paradox.