Declining Cirrhosis Hospitalizations in the Wake of the COVID-19 Pandemic: A National Cohort Study

The coronavirus disease-2019 (COVID-19) pandemic has caused abrupt shifts in US health care delivery.1 To preserve inpatient resources and minimize COVID-19 transmission, many health systems have expanded telemedicine, limited hospital transfers, and established stringent hospitalization criteria for non-COVID-19-related conditions. States have also enacted, on varying time-lines, shelter-in-place (SIP) or equivalent orders to further limit COVID-19 spread. The broader impact of these changes on health care utilization and outcomes in high-risk and vulnerable populations, such as those with cirrhosis, are unknown. To address these gaps, we used national data in the Veterans Health Administration (VHA), a single integrated system of care and the largest single US provider of liverrelated care, to (1) investigate the impact of the COVID-19 pandemic on the volume of national cirrhosis hospitalizations, and (2) identify salient changes in hospitalizationlevel characteristics.