COVID-19's Hidden Impact on Chronic Liver Disease Mortality in Nigeria: Findings from an 18-Year Retrospective Review.

Background: The COVID-19 pandemic disrupted healthcare systems globally, disproportionately affecting patients with decompensated chronic liver disease (DCLD) due to interrupted care, resource diversion, and the immunosuppressive state associated with DCLD.In Nigeria, where viral hepatitis is endemic, evidence on the pandemic's indirect impact on DC LD mortality remains scarce. This study examined 18-year mortality trends among patients who died from DCLD in North-eastern Nigeria and evaluated the influence of the COVID-19 pandemic on DCLD-related mortalities. Methodology: A retrospective review of 436 adult decedents with confirmed DCLD (2006-2024) was conducted at Modibbo Adama University Teaching Hospital, Adamawa State. Sociodemographic and clinical data were abstracted from records. Mortality trends were analysed using Poisson regression, changepoint detection, and joinpoint analysis to identify inflection years, focusing on 2020-2022 as the pandemic window. Results: The mean age at death was 50.3 ± 14.4 years; 74.5 % were male, and 76.1 % were from low-income households. Viral Hepatitis B & C infections were linked to 67.8 % of deaths, followed by alcohol use (30.1 %). Common complications included hepatic encephalopathy (83.8 %) and portal hypertension (58.2 %). Mortality rose steadily over 18 years, with an abrupt 8.7 % increase in 2020 (p < 0.01). Joinpoint analysis identified 2013 and 2020 as major inflection points. Conclusion: Mortality from DCLD in North-eastern Nigeria increased sharply during the COVID-19 pandemic. Viral hepatitis remains the dominant cause, compounded by late presentation and poor access to care. Strengthening hepatitis prevention, integrating CLD management into non-communicable disease programs, and maintaining chronic care continuity during health emergencies are crucial to mitigating future excess deaths.Top of FormBottom of Form.