The number of people with alcoholic hepatitis who received a liver transplant or were put on a waiting list rose more than 50% over predicted numbers during the pandemic, a new study finds. Researchers say the increase was associated with higher alcohol sales.

Alcoholic hepatitis is typically caused by heavy alcohol consumption on a regular basis. It can lead to permanent scar tissue in the liver and other long-term damage, like liver failure, if left untreated.

In the new study, researchers from the University of Michigan compared the number of new people placed on the U.S. organ transplant list from March 2020 to January 2021 with the projected figures based on pre-pandemic data. They also evaluated national monthly retail alcohol sales figures between January 2016 and 2021, CNN reports.

“While we cannot confirm causality, this study provides evidence for an alarming increase in alcoholic hepatitis associated with known increases in alcohol misuse during COVID-19,” researcher Maia S. Anderson, M.D., said in a news release. “And it highlights the need for public health interventions around excessive alcohol consumption.”