Alcohol-associated Cirrhosis and Alcoholic Hepatitis... : Journal of Clinical Gastroenterology (original) (raw)

LIVER, PANCREAS & BILIARY TRACT: Original Articles

Alcohol-associated Cirrhosis and Alcoholic Hepatitis Hospitalization Trends in the United States

*Department of Medicine, California Pacific Medical Center, San Francisco

‡Division of Gastroenterology and Hepatology, Alameda Health System—Highland Hospital, Oakland, CA

†University of South Dakota Sanford School of Medicine and Avera Transplant Institute, Sioux Falls, SD

F.S.: study concept and design, statistical analysis, analysis and interpretation of data, writing of the article. A.K.S.: analysis and interpretation of data, critical revision of the manuscript. R.J.W.: study concept and design, analysis and interpretation of data, critical revision of the manuscript, study supervision.

R.J.W. served as a member in advisory board, speaker’s bureau, and received research grants from Gilead Sciences and Abbvie. The remaining authors declare that they have nothing to disclose.

Address correspondence to: Robert J. Wong, MD, MS, Division of Gastroenterology and Hepatology, Alameda Health System—Highland Hospital, 1411 East 31st Street, Highland Hospital—Highland Care Pavilion 5th Floor, Oakland, CA 94602 (e-mail: [email protected]).

Abstract

Goals:

The goals of this study were to evaluate trends in hospitalizations and in-hospital mortality among US adults with alcohol-associated cirrhosis and alcoholic hepatitis.

Background:

Alcohol-associated liver disease contributes to significant liver-related morbidity in the United States, among which inpatient care is a major driver of clinical and economic burden.

Methods:

Using the 2007-2014 National Inpatient Sample, alcohol-associated cirrhosis and alcoholic hepatitis hospitalizations were identified. Survey-weighted annual hospitalization trends were stratified by sex, race/ethnicity, and age and compared using χ2 and Student’s _t_-test methods. Adjusted multivariate logistic regression models evaluated predictors of in-hospital mortality.

Results:

Among 159,973 alcohol-associated liver disease hospitalizations, 83.7% had a primary diagnosis of alcohol-associated cirrhosis and 18.4% had a primary diagnosis of alcoholic hepatitis. Sex-specific differences in hospitalizations emerged, with significantly higher hospitalization rates seen in males versus females among both alcoholic hepatitis [incidence rate ratio=3.71, 95% confidence interval (CI): 3.47-4.01, P<0.01] and alcohol-associated cirrhosis (incidence rate ratio=2.68, 95% CI: 2.21-3.71, P<0.01). Differences in hospitalization and mortality by ethnicity were observed for both alcohol-associated cirrhosis and alcoholic hepatitis. African Americans with alcohol-associated cirrhosis had significantly higher in-hospital mortality compared with non-Hispanic whites [odds ratio (OR)=1.13, 95% CI: 1.04-1.24, P<0.01], whereas Native Americans (OR=1.88, 95% CI: 1.06-3.34, _P_=0.030) and Asian/Pacific Islanders (OR=2.02, 95% CI: 1.00-4.06, _P_=0.048) with alcoholic hepatitis had significantly higher in-hospital mortality compared with non-Hispanic whites.

Conclusions:

This study demonstrated increasing alcohol-associated cirrhosis and alcoholic hepatitis hospitalizations in the United States. The highest rates were observed in men and among Native American and Hispanic ethnic minorities. Significant ethnicity-specific disparities in mortality were observed.