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Most excess years of potential life loss among individuals with cirrhosis during the pandemic were not related to COVID-19
  1. Yunyu Zhao1,
  2. Yee Hui Yeo2,
  3. Jamil Samaan2,
  4. Fan Lv3,
  5. Xinyuan He1,
  6. Ning Gao1,
  7. Justin Park4,
  8. Ju Dong Yang5,
  9. Walid Ayoub5,6,
  10. Michelle C Odden7,
  11. Fanpu Ji1,
  12. Mindie H Nguyen7,8
  1. 1 Department of Infectious Diseases, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
  2. 2 Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
  3. 3 School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
  4. 4 David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
  5. 5 Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  6. 6 Cedars-Sinai Medical Center Liver Diseases & Transplant Program, Los Angeles, California, USA
  7. 7 Department of Epidemiology and Population Health, Stanford University Medical Center, Stanford University, Palo Alto, California, USA
  8. 8 Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford University, Palo Alto, California, USA
  1. Correspondence to Prof. Mindie H Nguyen, Stanford University Medical Center; Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA 94305, USA; mindiehn{at}stanford.edu; Prof. Fanpu Ji, Department of Infectious Diseases, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China; jifanpu1979{at}163.com

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We read with interest the article by Dufour et al.1 The authors were to be commended for their comprehensive review on the presentations, pathophysiology and prognosis of COVID-19 in patients with chronic liver disease. Notably, the authors included data from multicentre and nationwide cohort studies to suggest decompensated cirrhosis as an independent risk factor for severe COVID-19 and death.1–6

However, while excess death from COVID-19 among patients with cirrhosis is important, the non-COVID-19-related excess death is integral in considering the degree of care disruption and delayed presentation, especially for those before 65 years of age. Thus, using the CDC WONDER website of the US National Vital Statistic System, which includes over 99% of deaths annually, we evaluated the percentage of excess years of potential life loss (YPLL) among individuals with cirrhosis during the pandemic and how much of these excess YPLL were directly versus indirectly related to COVID-19. Details of method are included in the online supplemental file. In brief, we included decedents with cirrhosis listed as one of the causes of death in the death certificate. We estimated cirrhosis-related premature deaths by calculating the YPLL.7 8 We then conducted forecast analysis to estimate the projected YPLL according to the pre-pandemic YPLL. Excess YPLL was defined by the difference between projected and observed YPLLs. Proportion of COVID-19 is …

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Footnotes

  • YZ and YHY contributed equally.

  • Contributors All authors: Data interpretation and approval the manuscript. YZ, YHY, FL, XH, FJ, MHN: Study design and data analysis. YZ, YHY, JS: Drafting of the manuscript. JDY, WSA, MCO, FJ: Critical review of the manuscript. MHN: Critical revision of the manuscript. FJ, MHN: Study conception and study supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests FJ: Speaker: Gilead Sciences, MSD and Ascletis. Consulting/advisory board: Gilead, MSD. MHN: Grants: Gilead, Pfizer, Enanta, Vir, Glycotest, National Cancer Institute, B. K. Kee Foundation, Exact Sciences, Helio Health, CurveBio; Consulting or advisory board: Intercept, Gilead, Exact Sciences, Laboratory of Advanced Medicine, Bayer, Eisai, GSK, Novartis.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.