Pre‐ to Post‐Pandemic Increases in Excessive Alcohol Use, Binge Drinking, and Associated Liver Fibrosis Among U.S. Adults

ABSTRACT Binge drinking and excessive alcohol consumption are major public health concerns, and the COVID‐19 pandemic may have exacerbated these issues. We aimed to compare the prevalence of binge and excessive alcohol use, as well as advanced liver fibrosis, among U.S. adults before and after the pandemic onset. We analysed 9533 adult participants from the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2023. Pre‐pandemic (2017–2020) and post‐pandemic (2021–2023) cycles were identified. Binge drinking was defined as ≥ 5 drinks/occasion for men or ≥ 4 for women, and excessive alcohol use as ≥ 2 drinks/day (men) or ≥ 1 (women). Advanced fibrosis was assessed using transient elastography (≥ 9.6 kPa). Logistic regression models, incorporating NHANES weights, were used to evaluate associations. Among 9533 participants, binge drinking prevalence increased from 21.5% (2017–2020) to 27.9% (2021–2023; p < 0.001), while excessive alcohol use rose from 12.5% to 14.3% ( p = 0.040). Notable increases in binge drinking were observed across multiple demographic groups, especially in older adults (≥ 60 years) and women. The prevalence of advanced fibrosis also significantly increased from 6.1% to 8.4% ( p = 0.011). Binge drinking was independently associated with an elevated risk of advanced fibrosis after adjusting for age, sex, and metabolic risk factors (OR = 1.496 [95% CI, 1.084–2.065]). Binge and excessive drinking increased notably in the post‐pandemic period, accompanied by rising rates of advanced liver fibrosis. These findings highlight the need for proactive screening, behavioural interventions, and policy measures to limit high‐risk alcohol use, particularly as populations at historically lower risk appear at higher risk.