Concomitant Psychiatric and Nonalcohol‐Related Substance Use Disorders Among Hospitalized Patients with Alcoholic Liver Disease in the United States

Jinjuvadia, Raxitkumar; Jinjuvadia, Chetna; Puangsricharoen, Pimpitcha; Chalasani, Naga; Crabb, David W.; Liangpunsakul, Suthat

doi:10.1111/acer.13567

Cited by 25 publications

(18 citation statements)

References 17 publications

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“…In addition to shared pathophysiology, CLD and SUD share common demographic traits which increase the risk of coexistence. In a previous study using the NIS, SUD hospitalization rates were higher in those with alcoholic CLD; however, this study excluded those with alcohol use disorder and did not look at trends over time ( 16 ). In our analysis, as hospitalization rates for CLD and SUD increase over time, the burden of comorbid CLD-SUD has persisted, making up 15% of all CLD or SUD admissions.…”

Section: Discussionmentioning

confidence: 99%

“…This trend highlights the challenges experienced by individuals with comorbid SUD and HCV ( 48 , 49 ). Similarly, those with alcoholic liver disease are more likely to have comorbid psychiatric and nonalcohol-related SUDs and experience fragmented care leading to poor outcomes ( 5 , 16 ). Barriers to treatment encompass system-level, provider-level, and individual-level factors in this at-risk population.…”

Section: Discussionmentioning

confidence: 99%

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Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

Desai

Greene

Nephew

et al. 2021

Clin Transl Gastroenterol

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INTRODUCTION: Chronic liver diseases (CLDs) and substance use disorders (SUDs) are increasingly prevalent and often coexist. Contemporary studies describing the characteristics and hospitalization trends of those with comorbid CLD-SUD are lacking. We aimed to characterize a population-based cohort with comorbid CLD-SUD and describe trends in these hospitalizations over time by individual-level characteristics. METHODS: We performed a cross-sectional analysis of the National Inpatient Sample from 2005 through 2017. Diagnosis codes were used to identify adult hospitalizations with CLD, SUD, or both. Bivariate and multivariate analyses were used to make comparisons between diagnosis categories. Unadjusted and age-adjusted trends in these hospitalizations were described over time. RESULTS: Of 401,867,749 adult hospital discharges, 3.2% had CLD-only and 1.7% had comorbid CLD-SUD. Compared with CLD-only, comorbid CLD-SUD hospitalizations resulted in higher inpatient mortality (3.1% vs 2.4%, P < 0.001) and were associated with younger age, male sex, Native American race, and urban and Western US location. Over time, comorbid hospitalizations grew 34%, and the demographics shifted with larger increases in hospitalization rates seen in younger individuals, women, Native Americans, and those publicly insured. In comorbid hospitalizations, alcoholic SUD and CLD decreased, but drug SUDs and nonalcoholic fatty liver diseases are fast-growing contributors. DISCUSSION: In this comprehensive analysis of US hospitalizations, comorbid CLD-SUD hospitalizations are increasing over time and lead to higher inpatient mortality than CLD alone. We further characterize the changing demographics of these hospitalizations, providing a contemporary yet inclusive look at comorbid CLD-SUD hospitalizations. These data can guide interventions needed to improve the poor outcomes suffered by this growing population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

Desai

Greene

Nephew

et al. 2021

Clin Transl Gastroenterol

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“…Operationalizing income status via method of payment for services-specifically Medicaid as a proxy for low-income status-is an established approach in the literature (e.g., Buck, Msall, Schisterman, Lyon, & Rogers, 2000;Hurt & Betancourt, 2015;Marcin, Schembri, & Romano, 2003;Schechter & Margolis, 1998) and has been used in studies utilizing HCUP data (e.g., Albrecht et al, 2010;Correa, Bardenheier, Elixhauser, Geiss, & Gregg, 2015). Based on previous studies, the analysis also controlled for multiple covariates (e.g., Correa et al, 2015;Friedman, Zhong, Gelaye, Williams, & Peterlin, 2018;Jinjuvadia et al, 2018), including age (continuous), urbanicity of patient (1 = central urban, 2 = suburban, 3 = exurban, 4 = rural, 5 = micropolitan, 6 = other), and hospital region of the county (1 = Northeast, 2 = Midwest, 3 = South, 4 = West).…”

Section: Methodsmentioning

confidence: 99%

Posttraumatic Stress Disorder Among Low‐Income Adolescents Experiencing Family–Neighborhood Income Disparities

Carbone

Holzer

Vaughn

2019

Journal of Traumatic Stress

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Certain neighborhood factors may increase the risk of exposure to trauma, therefore increasing the risk of posttraumatic stress disorder (PTSD). Other aspects of neighborhoods can be protective, such as neighborhood-based social relationships, which provide social support that buffers the risk of developing PTSD. The strength of these social relationships may not be as dependent on neighborhood conditions as much as they are contingent on socioeconomic similarities between neighborhood residents. Using a nationally representative sample of hospital emergency department admissions in the United States (N = 13,669,251), this study hypothesized that an interaction between family-level income and neighborhood-level income would be associated with adolescent PTSD. The results show that female adolescents who resided in the highest income areas were 1.39 times more likely, 95% CI [1.09, 1.77], to be diagnosed with PTSD than those who lived in the lowest income areas. This association was not statistically significant for male adolescents. Additionally, low-income female youth were nearly one-third more likely than their non-low-income counterparts to be diagnosed, odds ratio (OR) = 1.29, 95% CI [1.12, 1.48], whereas low-income male youth were nearly twice as likely than their non-low-income counterparts to be diagnosed, OR = 1.95, 95% CI [1.62, 2.34]. Furthermore, there was an interaction among both male and female adolescents such that lower-income adolescents living in higher-income areas had higher odds of a PTSD diagnosis compared to their higher-income peers in areas that were in the same median household income quartile.

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“…The prevalence of adjustment disorders, anxiety, depression, and posttraumatic stress disorder (PTSD) are higher in those with alcoholic liver disease (ALD) compared with those patients with nonalcoholic CLD. ALD is also the main cause of alcohol‐related morbidity, which accounts for 48% of all deaths from cirrhosis 6 . Patients are less likely to receive care for both psychiatric and addiction disorders but may receive care for only one or the other.…”

Section: Substance Use/abuse and Cldmentioning

confidence: 99%

Psychiatric Disorders and Their Treatment: Impact of Outcomes in Patients With Chronic Liver Disease

Holmes

Patel

Desai

2022

Clinical Liver Disease

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Psychological and substance use disorders are highly prevalent in persons living with chronic liver disease (CLD). This review will summarize the mechanisms through which comorbid psychiatric and substance use disorders impact CLD-related outcomes. Furthermore, this review will summarize evidence supporting the treatment of comorbid psychiatric and substance use disorders to improve CLDrelated outcomes. PsYCHOlOGiCal DisOrDers/DisTress anD ClDIt has been established that psychological disorders and distress are related to a range of poor outcomes, including more severe liver symptoms, more advanced liver histological abnormalities, higher liver disease-related mortality, and poor compliance with medical treatment.Even in the modern era of hepatitis C (HCV) treatment, psychological disorders and distress reduce the odds of treatment success. 1 Depression and anxiety are the most prevalent psychological disorders that impact patients with liver disease, with anxiety impacting 25% to 45% of CLD patient populations and depression impacting 29% to 72%. 2 The rates of depression vary across liver diagnosis; patients with nonalcoholic fatty liver disease (NAFLD) and HCV diagnosis demonstrate increased rates of depression, and patients with hepatitis B report a similar rate of depression to the general population. 3 Most of these studies were single center or cross-sectional. 2 We should also note a lack of consensus on the definitions of "depression" and "anxiety" used in studies. For example, scales such as the hospital anxiety and depression scale and patient health questionnaire-9 measure anxiety and depressive symptoms, while instruments such as the structured Abbreviations: ADHD, attention deficit hyperactivity disorder; ADL, activities of daily living; ALD, alcoholic liver disease; CLD, chronic liver disease; GAD, generalized anxiety disorder; HCV, hepatitis C; HRQOL, health-related quality of life; IL, interleukin; MDD, major depressive disorder; miRNA, microRNA; NAFLD, nonalcoholic fatty liver disease; OH, alcohol; PNPLA3, patatin-like phospholipase domain-containing protein 3; PTSD, posttraumatic stress disorder; TNFα, tumor necrosis factorα.

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Concomitant Psychiatric and Nonalcohol‐Related Substance Use Disorders Among Hospitalized Patients with Alcoholic Liver Disease in the United States

Cited by 25 publications

References 17 publications

Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

Posttraumatic Stress Disorder Among Low‐Income Adolescents Experiencing Family–Neighborhood Income Disparities

Psychiatric Disorders and Their Treatment: Impact of Outcomes in Patients With Chronic Liver Disease

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