Impact of Safety-Net Burden on In-Hospital Mortality and Hospitalization Costs Among Patients with Alcoholic Hepatitis and Alcoholic Cirrhosis

Abstract

Aims Alcoholic hepatitis (AH) and alcoholic cirrhosis disproportionately affect ethnic minority and safety-net populations. We evaluate the impact of a hospital’s safety net burden (SNB) on in-hospital mortality and costs among patients with AH and alcoholic cirrhosis. Methods We performed a cross-sectional analysis of 2012–2016 National Inpatient Sample. SNB was calculated as percentage of hospitalizations with Medicaid or uninsured payer status. Associations between hospital SNB and in-hospital mortality and costs were evaluated with adjusted multivariable logistic regression and linear regression models. Results Among 21,898 AH-related hospitalizations, compared to low SNB hospitals (LBH), patients hospitalized in high SNB hospitals (HBH) were younger (44.4 y vs. 47.4 y, P < 0.001) and more likely to be African American (11.3% vs. 7.7%, P < 0.001) or Hispanic (15.4% vs. 8.4%, P < 0.001). AH-related hospitalizations in HBH had a non-significant trend towards higher odds of mortality (OR 1.27, 95% CI 0.98–1.65, P = 0.07) and higher mean hospitalizations costs. Among 108,669 alcoholic cirrhosis-related hospitalizations, patients in HBH were younger (53.3 y vs. 55.8 y, P < 0.001) and more likely to be African American (8.2% vs. 7.3%, P < 0.001) or Hispanic (24.4% vs. 12.0%, P < 0.001) compared to LBH. Compared to alcoholic cirrhosis-related hospitalizations in LBH, mortality was higher among medium SNB (OR 1.10, 95% CI 1.03–1.17, P = 0.007) and HBH (OR 1.07, 95% CI 1.00–1.15, P = 0.05). Mean hospitalization costs were not different by SNB status. Conclusions HBH hospitals predominantly serve ethnic minorities and underinsured/uninsured populations. The higher in-hospital mortality associated HBH particularly for alcoholic cirrhosis patients is alarming given its increasing burden in the USA.

Alcohol‐associated liver disease in the United States is associated with severe forms of disease among young, females and Hispanics

“…31 For example, blacks and minorities with ALD were more likely to be admitted to hospitals with higher safety net burden (proportion of hospitalizations with Medicaid or uninsured payer status), with increased odds (95% CI) of in-hospital mortality at 1.07 (1.00-1.15, P = 0.05). 15 Hospitals with higher safety net burden compared to those with lower safety net burden admitted more blacks (8.2% vs 7.3%) and Hispanics (24% vs 12%) in this study, P < 0.001 for both. In another study on AH-related hospitalizations, healthcare utilization and mortality differed for race/ethnicity with higher total hospital charges among Hispanics and lower inpatient mortality in blacks.…”

“…It contains data from over 7 million hospital discharges annually yielding the national estimates of hospital inpatient stays. The NIS includes up to 25 discharge diagnoses using the International Classification of Diseases (ICD) codes as reported previously 12,15 . The clinical discharge records also include patient demographics, payer status, procedure codes, hospital costs, co‐morbidities, inpatient mortality, and hospital characteristics such as region and teaching status.…”

“…The NIS includes up to 25 discharge diagnoses using the International Classification of Diseases (ICD) codes as reported previously. 12,15 The clinical discharge records also include patient demographics, payer status, procedure codes, hospital costs, comorbidities, inpatient mortality, and hospital characteristics such as region and teaching status. ALD-related hospitalizations in the NIS database (2006-2016) were identified using one of the discharge diagnosis codes (ICD-9 prior to October 2015: 571.2 for alcohol associated cirrhosis, 571.1 for alcoholic hepatitis and ICD-10 codes for last quarter of 2015 and for 2016: K70.30 and K70.31 for alcohol associated cirrhosis, K70.10 and K70.11 for alcoholic hepatitis).…”

“…ALD-related hospitalizations in the NIS database (2006-2016) were identified using one of the discharge diagnosis codes (ICD-9 prior to October 2015: 571.2 for alcohol associated cirrhosis, 571.1 for alcoholic hepatitis and ICD-10 codes for last quarter of 2015 and for 2016: K70.30 and K70.31 for alcohol associated cirrhosis, K70.10 and K70.11 for alcoholic hepatitis). 12,15 2.1.3 | Liver transplants UNOS, a large nonprofit organization under contract with federal government maintains transplant-related data for every organ including liver for donors, listed candidates with waitlist outcomes, and transplant recipients with posttransplant outcomes. ALD-related LT listings were identified in the UNOS database (2006-2016) using specific codes: 4215 for alcohol associated cirrhosis and 4217 for alcoholic hepatitis.…”

Racial and Health Disparities among cirrhosis related hospitalizations in the US

“…Primary outcome was ALD as cause for hospitalization, identi ed using the ICD-10 codes (K70.30 and K70.31 for AC, K70.10 and K70.11 for AH), Supplementary Table 1. [5,11] Secondary outcome was hospitalization with one of the discharge diagnoses of AH.…”