Deviation from Trend in Death Rates from Liver Disease (ICD10 codes: K70-K76)
We generalise for all age groups the detailed analysis of trends in death rates from liver diseases. We compute the excess deaths (deviation from 2013-2019 trend) from liver diseases (ICD-10 codes: K70-K76) for the different age groups in the US.
The data for age groups 1, 1-4 and 5-14 cannot be computed as the number of deaths in these age groups are very low, falling below CDC suppression limitations that do not allow for publication.
Excess UC (Underlying-Cause) Death Rates from Liver Diseases, 10y age groups
In this section, we compute for all age groups, the excess UC death rates from liver diseases in 2020, 2021, 2022 and 2023, shown in the Figure below. The detailed results are also shown in the full paper, in the tables in section 8.1 of the appendix.
The left Figure shows the excess UC death rate (in percent) and in the right Figure the respective Z-scores are shown. Each datapoint on the graphs is obtained by performing the analysis described in the methodology section where the extrapolated 2013-2019 trendline in death rates is subtracted from the death rates in 2020, 2021, 2022 and 2023, for each of the age groups.
The results from the Figures above show that the excess UC death rates from liver diseases had a higher impact (in percentage terms) on younger individuals when compared to older individuals. The results show that excess death rates tend to be higher the lower the age-group, with the 15-24 age group being the most impacted with increased liver disease death rates. As for older individuals, aged 75 and above, they experienced much lower excess death rates in 2020, 2021, 2022 and 2023.
For individuals aged 65 and younger, the Figures above show that we observe statistically significant excess death rates from liver diseases, that started in 2020, peaked in 2021 and then dropped in 2022 and 2023. The pattern of excess deaths from liver diseases for these age groups closely tracks changes in all-cause mortality from 2020 to 2023. For example, within these age groups, as shown in the Figure, the largest percentage of excess deaths were observed in the 15-24 age group, where excess death rates were 45.4% (Z-score: 5.7) in 2020, 55.1% (Z-Score: 6.9) in 2021, 70.9% (Z-Score: 8.9) in 2022 and 42.5% (Z-Score: 5.4) in 2023. For a more detailed analysis see section 8.1 in the appendix of the full paper shows all the individual values that are plotted in the Figure above.
As we’ve shown previously in Figure 4, for younger individuals, alcoholic liver disease was the main contributor to changes in death rates from liver diseases from 2020 to 2023. Consequently, increased levels of alcohol consumption during the pandemic years, could be a contributory factor towards increased liver disease deaths (Slater & Alpert, 2024).
The pattern of excess deaths was different for individuals aged 75 and above, showing much lower excess death rates (in percentage terms) than those for younger age groups. Notwithstanding, the statistical significance of the excess deaths rates show very high statistical significance from 2021 onwards, due to the larger sample sizes for older individuals when compared to younger individuals. For older individuals, excess deaths rose consecutively from 2020 to 2023, with the main increase in excess mortality starting in 2021 and not in 2020 as was the case for younger individuals. As we’ve shown in the analysis of older individuals (ages 75-84), cirrhosis and fibrosis of the liver was the main contributor to changes in deaths rates from liver diseases from 2020 to 2023. Consequently, increased levels of alcohol consumption during the pandemic years, are unlikely to be a significant contributory factor towards increased liver disease deaths for older individuals.
For the older age groups, excess deaths increased substantially in 2021, 2022 and 2023, showing extreme deviations from the prior 2013-2019 trend. Additionally, as illustrated by the detailed analysis of the 75-84 age group , even as excess all-cause deaths declined in 2022 and 2023, excess death rates from liver diseases continued to rise. The results suggest that the COVID-19 disease, pandemic lockdowns, or increased alcohol consumption are unlikely explanations for the rise in excess liver disease death rates, for older individuals. The prioritisation of older individuals to receive the COVID-19 inoculations or cumulative exposure to SARS-Cov2, might be better explanations for the observed pattern.
Excess MC* (Multiple-Cause except COVID-19) Death Rates from Liver Diseases, 10y age groups
In this section we compute, for all 10-year age groups, the excess MC* death rates from liver diseases (K70-K76) in 2020, 2021, 2022 and 2023, shown in the Figures below (MC* excess death rates). As a reminder, MC* death rates refer to MC deaths from liver diseases except for those where COVID-19 is also reported (either as underlying cause or a contributing cause). In the Figure (left) we plot the excess MC* death rate (in percent) while Figure (right) shows the respective Z-scores. For a detailed view of the results refer to section 8.1, in the appendix of the full paper.
After removing COVID-19-related deaths, the results show that the excess MC* death rates exhibit a similar pattern to UC excess death rates for the different age groups. This is likely due to the rise in MC* death rates being driven by the rises in UC death rates.
For older individuals, aged 75-84 and 85+, after removing COVID-19-related deaths, we observe statistically insignificant excess MC* death rates in 2020, in similarity to observed for UC death rates. Excess death rates rose substantially from 2021, remaining high in 2022 and 2023, with very high statistical significance.
For individuals aged 65 and younger, excess death rates peaked in 2020 and 2021 and then declined in 2022 and 2023. The excess death rates in general show very high levels of statistical significance, as shown in Figure (Right) above. For younger individuals, the brunt of the effect was felt in 2020 and 2021, while for older individuals, the excess death rates peaked in 2023.
Observations
-
When investigating excess death rates from liver diseases (ICD-10 codes: K70-K76) from 2020 to 2023 for the distinct 10-year age groups, we observe two different patterns of behaviour for individuals aged 65 and younger and for individuals aged 75 and older, with individuals aged 65-74 falling somewhere in the middle. The previously presented detailed analysis of excess death rates from liver diseases for younger individuals aged 35-44 and for older individuals aged 75-84 are case studies that exemplify each of these patterns of behaviour.
-
We show in Figure 11 that for younger individuals, aged 65 and lower, excess death rates from liver diseases started in 2020 and peaked in 2021, subsequently dropping in 2022 and 2023. The pattern of excess deaths from liver diseases for younger individuals tracks changes in all-cause mortality from 2020 to 2023. As we’ve shown in Figure 4, for younger individuals, the principal driver of changes in death rates from liver disease in 2020, 2021, 2022 and 2023 was alcoholic liver disease (ICD-10 code: K70).
-
Consequently, the increased levels of alcohol consumption per capita that was observed in 2020, 2021 and 2022 (Slater & Alpert, 2024), was a likely contributory factor towards increased liver disease death rates during the period. Although not being within the scope of this paper, we performed a quick analysis of the changes in alcohol consumption per capita to see if it could fully explain the increases in death rates from alcoholic liver disease and our preliminary analysis suggested that it cannot. Interestingly, however, we observe that the increase in alcoholic liver disease death rates is mostly driven by increases in spirits consumption and less so by wine and beer. We noticed that accounting for increases in alcohol consumption per capita only explain a fraction of the increase in death rates, suggesting that other additional factors are at play. These factors could be either the societal lockdowns and pandemic-related changes in lifestyles (in 2020), sequalae from the COVID-19 disease (in 2020 through 2023), or COVID-19 vaccinations (from 2021 onwards).
-
In particular, a significant body of evidence is now pointing towards the COVID-19 vaccinations playing a significant role in contributing towards the excess all-cause mortality in 2021, 2022 and 2023 that is observed in developed countries with high COVID-19 vaccine intake. For example, a recent paper from Alexandria et al. (Alessandria, Malatesta, Berrino, & Donzelli, 2024), show that individuals with 2 or more vaccine doses experienced about 20% higher excess all-cause mortality (measured as all-cause death hazard ratios) when compared to unvaccinated individuals in a province in Italy. The paper confirms previous suspicions that were already present in the Pfizer clinical trials (Michels, et al., 2023) where the authors show that of the 38 deaths reported in the 6-Month Interim Report of Adverse Events, 21 BNT162b2 vaccinated subjects died compared to 17 placebo subjects, which corresponds to 23.5% excess all-cause mortality. Even though the sample size was small and not possible to infer statistical significance, the recent paper from Italy provided confirmation of the signal at a population level. Furthermore, the analysis of serious adverse events (SAE) of special interest in the Moderna and Pfizer clinical trials (Fraiman, et al., 2022) showed to the Pfizer trial exhibited a 57% higher risk of an SAE of special interest in vaccinated participants relative to the placebo control and 36% higher risk for the Moderna trial. The estimated rate of SAEs of special interest for both clinical trials combined was 1 in 800 for the recipients of these vaccines.
-
Finally, the Nonclinical Evaluation Report BNT162b2 [mRNA] COVID-19 vaccine submitted to the Australian TGA (TGA - Health Safety Regulation, 2021) show that the vaccine was not confined to the injection site but distributed across almost all important organs of the body with particular accumulation in the liver (page 45 of the report) as stated in the conclusions: “Slow but significant distribution of lipid nanoparticles from the site of injection with major uptake into liver”, which could explain the liver being particularly impacted by production of the toxic spike protein.
-
The pattern of excess deaths was different for older individuals aged 75 and above, showing much lower excess death rates (in percentage terms) than those for younger age groups. For older individuals, excess deaths rose consecutively from 2020 to 2023, with the main increase in excess mortality starting in 2021 and not in 2020 as was the case for younger individuals. For the older age groups, excess deaths increased substantially in 2021, 2022 and 2023, showing extreme deviations from the prior 2013-2019 trend. Additionally, as illustrated by the detailed analysis of the 75-84 age group , even as excess all-cause deaths declined in 2022 and 2023, excess death rates from liver diseases continued to rise.
-
As we’ve mentioned previously, for older individuals, cirrhosis and fibrosis of the liver was the main contributor to changes in deaths rates from liver diseases from 2020 to 2023. Consequently, increased levels of alcohol consumption during the pandemic years, are unlikely to be a significant contributory factor towards increased liver disease deaths for older individuals.
-
The results suggest that COVID-19 pandemic lockdowns are also unlikely explanations for the rise in excess liver disease death rates, for older individuals, as excess death rates were subdued in 2020. As excess deaths continued to rise in 2022 and 2023, indicating a worsening of the phenomenon that is leading to excess liver disease deaths. As previously explained, there is more and more evidence that this could be related to continuous uptake of COVID-19 inoculations within the older age groups (Alessandria, Malatesta, Berrino, & Donzelli, 2024).
-
One cannot exclude other possible contributing factors such as pandemic-related changes in lifestyles, inflammatory processes due to cumulative exposures to SARS-CoV-2, “Long COVID” (Jangnin, et al., 2024) or other factors.
Other components of Liver Disease Deaths report:
PHINANCE TECHNOLOGIES