Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians

Abstract

Background Limited information is available about hospitalization rates for cirrhosis in Australia. Methods Using information on all hospital episodes of care for patients admitted to Queensland hospitals during 2008–2016, we report age-standardized hospitalization rates/10,000 person-years, in-hospital case-fatality rate among these admissions (n = 30,327), and examine the factors associated with hospital deaths using logistic regression analyses. Findings Hospitalization rates increased from 8.50/10,000 (95% confidence interval (CI) 8.18–8.82) to 11.21/10,000 (95%CI 10.87–11.54) between 2008 and 2016, and peaked in men aged 55–59 years (34.03/10,000) and in Indigenous Australians (32.79/10,000). The number of admissions increased by 61.7% from 2701 admissions in 2008 to 4367 in 2016. During the same period, the percentage increase varied by socioeconomic disadvantage (3.2%/year in the most affluent vs. 9.4%/year in the most disadvantaged quintile; p < 0.001). Alcohol misuse was a contributing factor for cirrhosis in 55.1% of admissions, and socioeconomic disadvantage in 26.8%. The overall in-hospital case-fatality rate was 9.7% for males and 9.3% for females, and decreased in males (p < 0.001). Predictors of in-hospital mortality included hepatorenal syndrome (adjusted odds ratio (AOR) = 7.24, 95%CI 5.99–8.75), HCC (AOR = 2.53, 95%CI 2.20–2.91), hepatic encephalopathy (AOR = 1.94, 95%CI 1.61–2.34), acute peritonitis (AOR = 1.93, 95%CI 1.61–2.33), jaundice (AOR = 1.82, 95%CI 1.20–2.75), age ≥ 70 years (AOR = 1.63, 95%CI 1.38–1.92), a higher comorbidity index (p = 0.021), and residence outside of a “major city” (p < 0.001). Interpretation The increasing healthcare use by Australians with cirrhosis has resource and economic implications. Our data highlight the disproportionate impact of cirrhosis on Indigenous Australians and people from the most socioeconomically disadvantaged areas. Funding .

Aeromedical retrievals for gastrointestinal disorders in rural and remote Australia: the need for improved access to specialist advice

“…Liver disease also contributed to aeromedical retrievals for GI disorders (3.6%; n = 217). This finding is consistent with research that indicates that rural and remote populations have higher rates of untreated hepatitis C and increased prevalence of excessive alcohol consumption, both of which are linked to liver cirrhosis and cancer . This, coupled with the increasing rates of substance use disorders requiring aeromedical retrieval, indicates a complex clinical environment …”

Type 2 Diabetes: A Risk Factor for Hospital Readmissions and Mortality in Australian Patients With Cirrhosis

“…In Australia, hospital admissions for cirrhosis increased by 61.7% during 2008-2016, with alcohol misuse a cause or contributing factor for cirrhosis in over half the admissions. (12) Importantly, the burden of T2D as a comorbidity in these patients has also been increasing, with an increase in prevalence of T2D from 13.7% in 2008-2010 to 25.4% in 2014-2016. (12) Although there is evidence that T2D impacts adversely on liver-related mortality, its influence on hospital readmissions and development of complications in patients with cirrhosis (particularly in ALD, the most common etiological factor among Australian hospital admissions for cirrhosis) has not been well studied.…”

“…(12) Importantly, the burden of T2D as a comorbidity in these patients has also been increasing, with an increase in prevalence of T2D from 13.7% in 2008-2010 to 25.4% in 2014-2016. (12) Although there is evidence that T2D impacts adversely on liver-related mortality, its influence on hospital readmissions and development of complications in patients with cirrhosis (particularly in ALD, the most common etiological factor among Australian hospital admissions for cirrhosis) has not been well studied. In this population-based study, we examined the association between T2D and patient outcomes (survival and readmission) among patients admitted for cirrhosis in the state of Queensland, Australia.…”

“…As previously reported, we defined an admission for cirrhosis as when a patient was hospitalized for a primary diagnosis of any of the following: alcoholic fibrosis and sclerosis of liver, alcoholic cirrhosis of liver, alcoholic hepatic failure, chronic hepatic failure, fibrosis and cirrhosis of liver, primary biliary cirrhosis/cholangitis, secondary biliary cirrhosis, biliary cirrhosis, portal hypertension, hepatorenal syndrome, gastroesophageal varices, HCC, and unspecified, other, and unspecified cirrhosis of liver. (12) Patients who had any of the above-mentioned diagnoses as "other" diagnosis and a cirrhosis-related diagnosis or procedure as primary diagnosis (e.g., abdominal paracentesis) were also included. (12) See Supporting Information for further details about the definition of an admission for cirrhosis, including the list of International Classification of Diseases, Tenth Revision (ICD-10) diagnosis and procedure codes used.…”

Hepatocellular carcinoma surveillance in Australia: time to improve the diagnosis of cirrhosis and use liver ultrasound

“…However, the four major causes of cirrhosis in Australia are non‐alcoholic fatty liver disease, alcohol‐related liver disease, hepatitis C infection, and hepatitis B infection . At least 50% of patients with cirrhosis have at least two of these causes . Pharmaceutical Benefits Scheme‐funded treatments for hepatitis C will result in a reduction of HCC related to this cause in the next 10 years .…”