Pittsburgh —Serious alcohol-related complications among middle-aged women increased dramatically during the COVID-19 pandemic, according to new research from the University of Pittsburgh.

The study looked at medical insurance billings from a population of 14 million patients and found that in 16 of the 18 months of the COVID-19 pandemic, middle-aged women had higher-than-expected rates of hospital admissions for alcohol-related liver disease.

"We anticipated finding some increase in hospitalizations for alcohol-related complications among women," said Bryant Shuey, assistant professor of medicine at the University of Pittsburgh and lead author of the study, published Friday in JAMA Health Forum. "We didn't realize it would be this stark."

For 10 of the 18 months, middle-aged women had higher-than-expected hospital admissions for general alcohol-related complications. In those 10 months, those complications increased 33.3% to 56% among middle-aged women.

In the population as a whole, the study found higher-than-expected rates of alcohol complications in four of the 18 pandemic months. Those complications resulted from alcohol-related disorders such as cirrhosis, hepatitis, withdrawal and heart disease.

"We know that drinking has increased among women over the last decade and that women, particularly compared to men, increased alcohol use during the pandemic," said Shuey, who is also a physician who treats patients with alcohol use disorders. "Our study adds to a grouping of studies now which really raise the alarm bells to say that the gap between men and women is narrowing and we need to intervene."

It is possible that the study actually undercounted the amount of increases in hospital admissions, said Shuey, because it relied on medical coding of each admission as alcohol-related. A hospital visit billed simply as liver disease would not have been counted in the study, even if it was due to alcohol-related causes.

While the study did not investigate reasons for increased alcohol use among middle-aged women during the pandemic, possible causes could be pandemic-related social isolation, stress caused by bearing a disproportionate amount of the parenting burden and marketing campaigns aimed at women.

Shuey began the research during a fellowship at Harvard Medical School and continued it after coming to Pitt in August. Researchers from Harvard, Emory, Washington University and Duke also contributed to the study.

Further research will likely explore how the pandemic affected treatment options for those using alcohol excessively, and whether there is still a gap in patients' access to those services.

The study also recommended that policymakers take action to combat growing alcohol-related deaths.

"More people died last year from alcohol than from all drug overdoses combined," said Shuey. "There needs to be further attention to enacting policies that reduce the negative effects — we need to protect people from the harmful effects of alcohol."