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Reviewed by Megan Craig, M.Sc. Jul 12 2023

Excessive drinking during the covid-19 pandemic increased alcoholic liver disease deaths so much that the condition killed more Californians than car accidents or breast cancer, a KFF Health News analysis has found.

Lockdowns made people feel isolated, depressed, and anxious, leading some to increase their alcohol intake. Alcohol sales rose during the pandemic, with especially large jumps in the consumption of spirits.

While this led to a rise in all sorts of alcohol-related deaths, the number of Californians dying from alcoholic liver disease spiked dramatically, with 14,209 deaths between 2020 and 2022, according to provisional data from the Centers for Disease Control and Prevention.

Alcoholic liver disease is the most common cause of alcohol-induced deaths nationally. In California, the death rate from the disease during the last three years was 25% higher than in the three years before the pandemic. The rate peaked at 13.2 deaths per 100,000 residents in 2021, nearly double the rate from two decades ago.

The disease is usually caused by years of excessive drinking, though it can sometimes occur after a short period of heavy alcohol use. There are often no symptoms until late in the disease, when weakness, confusion, and jaundice can occur.

Many who increased their drinking during the pandemic were already on the verge of developing severe alcoholic liver disease, said Jovan Julien, a postdoctoral researcher at Harvard Medical School. The extra alcohol sped up the process, killing them earlier than they would have otherwise died, said Julien, who co-wrote a modeling study during the pandemic that predicted many of the trends that occurred.

Even before the pandemic, lifestyle and dietary changes were contributing to more deaths from alcoholic liver disease, despite little change in alcohol sales, said Brian Lee, a hepatologist and liver transplant specialist with Keck School of Medicine of the University of Southern California.

Lee and other researchers found a connection between alcoholic liver disease and metabolic syndrome, a condition often characterized by excess body fat around the waist. Metabolic syndrome — often caused by poor diet and an inactive lifestyle — has risen across the country.

"Having metabolic syndrome, which is associated with obesity, high blood pressure, and diabetes, more than doubles your risk of having advanced liver disease at the same level of drinking," Lee said.

The Californians alcoholic liver disease most often kills are those between 55 and 74 years old. They make up about a quarter of the state's adults but more than half the deaths from alcoholic liver disease.

However, death rates among Californians 25 to 44 roughly doubled during the last decade. About 2,650 Californians in that age group died of the disease during the last three years, compared with 1,270 deaths from 2010 through 2012.

"People are drinking at earlier levels," Lee said. "People are developing obesity at younger ages."

The highest death rates from alcoholic liver disease occur in rural eastern and Northern California. In Humboldt County, for instance, the death rate from alcoholic liver disease is more than double the statewide rate.

Jeremy Campbell, executive director of Waterfront Recovery Services in Eureka, said Humboldt County and other rural areas often don't have the resources and facilities to address high rates of alcohol use disorder. His facility provides high-intensity residential services and uses medication to get people through detox.

"The two other inpatient treatment facilities in Eureka are also at capacity," he said. "This is just a situation that there's just not enough treatment."

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Campbell also pointed to the demographics of Humboldt County, which has a much higher proportion of white and Native American residents than the rest of the state. Alcoholic liver disease death rates in California are highest among Native American and white residents.

Death rates rose more among Native American, Latino, Asian, and Black Californians during the last decade than among non-Latino white Californians, CDC data shows. Part of that is due to disparities in insurance coverage and access to care, said Lee. In addition, Lee said, rates of metabolic syndrome have increased more quickly among nonwhites than among whites. Racial health disparities also manifest in differing survival rates for Black and white patients after liver transplants, he added.

The trend is expected to continue. Julien projects a temporary dip in deaths because many people who would have died of the disease in 2022 or 2023 instead died sooner, after a boost in drinking during the pandemic, but that deaths will rise later as bad habits developed during the pandemic begin to take a long-term toll.

"As people increased their consumption during covid-19, we have more folks who have now initiated alcohol use disorder," Julien said.

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Sean ‘Diddy’ Combs’s ‘private sex life’ turned into ‘crime scene’, defence says in closing argument

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Sean 'Diddy' Combs's 'private sex life' turned into 'crime scene', defence says in closing argument

Sean “Diddy” Combs is facing a “fake trial” in which his unusual sexual preferences have been unfairly criminalised and his “private sex life” turned into a “crime scene”, his defence team has argued in the final day of closing arguments.

At the end of week seven in the sex-trafficking trial, Combs’s lead counsel, Marc Agnifilo, told the court Combs was the victim of an overzealous prosecution, who had portrayed his “swinger” lifestyle as a racketeering conspiracy.

Sean "Diddy" Combs listens as his lawyer Marc Agnifilo makes his closing arguments. Pic: Reuters
Image:
Combs listens as his lawyer Marc Agnifilo makes his closing arguments. Pic: Reuters

Combs is charged with one count of racketeering conspiracy, two charges of sex trafficking, and two charges of transportation to engage in prostitution.

He has pleaded not guilty to all charges and has strenuously denied all allegations of sexual abuse. If found guilty, he could face being put behind bars for life.

Diddy trial: As it happened

Frequently adopting a sarcastic tone, Agnifilo mocked the government’s case against Combs, belittling the agents who seized hundreds of bottles of Astroglide lubricant and baby oil at his properties last year.

Commenting that America’s streets were now “safe from Astroglide”, he went on, “Way to go, fellas”, before adding, “you do you”.

More on Sean Combs

He said prosecutors had “badly exaggerated” the evidence against Combs, presenting “threesomes as racketeering”, arguing that he is not guilty of racketeering conspiracy and sex trafficking.

The defence also highlighted the prosecution’s decision to indict Combs on a racketeering conspiracy charge alone, flagging that no alleged co-conspirators have been indicted alongside him.

The defence’s closing arguments lasted for just over four hours, with members of Combs’s family, including six of his children and his mother, watching on in the public gallery.

A court sketch of Sean "Diddy" Combs. Pic: Reuters
Image:
A court sketch of Sean ‘Diddy’ Combs. Pic: Reuters

Agnifilo said Combs has “taken care of people”, including Jane, a former girlfriend who testified under a pseudonym, paying for her rent and for her legal representation.

The defence lawyer said: “I don’t know what Jane is doing today, but she’s doing it in a house he’s paying for.”

He went on: “This isn’t about crime. It’s about money. This is about money.”

Presenting the trial as a zero-sum game, he described his former girlfriend of almost 11 years Cassie Ventura as the “winner in this whole thing”, noting that she settled her civil case with Combs for $20m (£14m) in November 2023, as well as a $10m (£7.3m) from the InterContinental Hotel.

Cassie and Jane both gave evidence during the trial that they were coerced repeatedly by Combs to perform in drug-fuelled, days-long sex marathons with male sex workers, while Combs watched, directed, masturbated and sometimes filmed the encounters.

But the defence accused prosecutors of having invaded Combs’s bedroom and his most intimate personal affairs.

Agnifilo asked: “Where’s the crime scene? It’s [Combs’s] sex life.”

Continuing his line of sarcastic quips, he joked, “We need a bigger roll of crime scene tape”, referencing a line from the classic movie Jaws.

Agnifilio’s sarcasm irked the prosecution, who later complained to the judge that he was using “improper arguments”.

Diddy and Cassie on a red carpet in 2016. Pic: zz/JMA/STAR MAX/IPx/AP
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Diddy and Cassie in 2016. Pic: zz/JMA/STAR MAX/IPx/AP

Read more:
Everything you need to know about the trial
The rise and fall of Sean ‘Diddy’ Combs
What we learned from Cassie’s testimony

The defence characterised Combs’s relationship with Cassie as “a great modern love story”, going on to describe her as a “gangster” for cheating on him with rapper Kid Cudi.

They also characterised the “freak offs” as “beautiful”, saying the videos showed “everyone smiling”, eating and listening to music, and commenting that Combs was “not the only man in America making homemade porn”.

The defence admitted Combs was a domestic abuser, but said such behaviour did not justify the grave charges he faces.

Agnifilo advised the jury to “Call this as you see it,” asking them to “acquit Sean Combs of all the counts” and “return him to his family”, who he said has been waiting for him.

Combs, who has been in a New York jail since his arrest in September last year, did not give evidence during the trial.

Following the defence’s closing argument, assistant US attorney Maurene Comey delivered a rebuttal summation in which she said the defence’s argument that Cassie, Jane and Mia, a former employee who also testified under a pseudonym, all “wanted sex” was a lie, telling the court none of the women had reason to speak anything other than the truth.

She also said the “freak off” videos tell only “part of the story”.

Comey said Combs had spent the last 20 years believing himself to be “above the law”, seeing himself as “untouchable” and “a god among men”.

She said his impunity would end now in this courtroom, before urging the jury to “find him guilty” and “hold him accountable”.

On Monday, the judge will read the law to the jury, after which deliberations will begin.

To convict Combs, the 12 jurors must vote unanimously.

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Angels’ Washington to miss remainder of season

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Angels' Washington to miss remainder of season

Los Angeles Angels manager Ron Washington will remain on medical leave for the rest of the season, the team announced Friday.

Bench coach Ray Montgomery will manage the team for what remains of 2025. Ryan Goins will serve as his bench coach going forward.

Washington, the oldest manager in the major leagues at 73, was placed on leave last Friday because of an undisclosed medical issue. He experienced shortness of breath and appeared fatigued toward the end of a four-game series at the New York Yankees that ended on June 19. Washington flew back to Southern California, underwent a series of tests and was placed on medical leave.

A longtime third-base coach and well-regarded infield instructor, Washington served as the Texas Rangers‘ manager from 2007 to 2014.

He was in his second year managing the Angels.

The Angels were 40-40 entering Friday night’s game against the visiting Washington Nationals, winning three straight under Montgomery and seven of 10 overall. Los Angeles has played better than most expected from a team with major league-worst streaks of nine straight losing seasons and 10 straight non-playoff seasons.

The 55-year-old Montgomery is getting his first job as a major league manager. The native of New York’s Westchester County is a former Houston Astros outfielder who served as the scouting director for Arizona and Milwaukee before joining the Angels as their director of player personnel for the 2020 season.

Montgomery became Los Angeles’ bench coach in 2021 after general manager Perry Minasian took over the front office, and he stayed with the Angels while Joe Maddon, Phil Nevin and Washington managed the club.

Goins played eight seasons in the major leagues before Washington hired him as the Angels’ infield coach before the 2024 season.

Information from The Associated Press was used in this report.

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Martinez’s near no-hitter, Steer’s 3 HRs lift Reds

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Martinez's near no-hitter, Steer's 3 HRs lift Reds

CINCINNATI — Nick Martinez took a no-hit bid into the ninth inning before allowing pinch hitter Elias Diaz‘s double and Spencer Steer hit three home runs, leading the Cincinnati Reds over the San Diego Padres 8-1 on Friday night.

Martinez (5-8) walked his third batter, Jackson Merrill, on a low full-count sinker, then retired 22 consecutive hitters before walking rookie Trenton Brooks starting the ninth. Diaz then drove an 0-1 changeup off the base of the wall in left-center on Martinez’s 112th and final pitch, which tied his career high.

A 34-year-old right-hander, Martinez struck out six as the Reds won for the fourth time in five games. He also threw 112 pitches for Texas against Boston on May 28, 2015.

Taylor Rogers walked a pair of batters, forcing in a run, before striking out Gavin Sheets.

Coming off a pair of relief appearances, Martinez made his first start since June 19. He entered with one complete game over 118 big league starts, an eight-inning effort in a loss at the Chicago Cubs last Sept. 27.

After Martinez allowed seven runs over 2⅔ innings against Minnesota, Reds manager Terry Francona suggested he make a relief appearance. Martinez threw two perfect innings at St. Louis two days later, and Martinez offered to making another bullpen outing to keep starter Brady Singer on turn. Martinez pitched a 1-2-3 innings against the Yankees on Monday.

Steer hit solo homers in the second and fourth innings off Dylan Cease (3-7), then a two-run drive against Yuki Matsui in a four-run fifth. Steer has nine home runs this season.

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