Racial Disparities in Alcoholic Hepatitis Hospitalizations in the United States: Trends, Outcomes, and Future Projections

Abstract

Introduction:Alcoholic Hepatitis (AH) is a serious complication of alcohol consumption with high morbidity and mortality, particularly in the United States where alcohol-related liver diseases rank as one of the leading causes of preventable death. Our study aims to analyze the morbidity and mortality of AH across racial groups and project hospitalization trends up to 2028, thereby informing public health initiatives. Methods:We conducted a cross-sectional study utilizing data from the Nationwide Inpatient Sample (NIS) spanning 2012 to 2021. The study population comprised hospitalizations identi ed using speci c ICD-9-CM and ICD-10-CM codes for AH. We assessed hospitalizations, in-hospital mortality rates, length of stay (LOS), and morbidities related to alcoholic hepatitis adjusting for sociodemographic factors and hospital characteristics. Statistical analyses were performed using Stata and R software, employing logistic and linear regression analyses, and SARIMA models for forecasting. Results:Our results indicated a predominantly White cohort (68%), with a notable increase in AH hospitalizations among Hispanics (129.1% from 2012 to 2021). Racial disparities were observed in inpatient mortality, liver transplant accessibility, and the occurrence of in-hospital complications. The study forecasts a continued rise in hospitalizations across all racial groups, with Hispanics experiencing the sharpest increase. Conclusion:Our study reveals a disproportionate rise in the AH burden among Hispanics with projections indicating a persistent upward trend through 2028. These ndings highlight the need for targeted public health strategies and improved healthcare access to mitigate the increasing AH burden and address disparities in care and outcomes.In the United States, excessive alcohol consumption ranks as the third leading cause of preventable death. Surveys indicate that 68% of American adults consume alcohol monthly, with 10% classi ed as heavy drinkers (3,4). AH's incidence is challenging to determine due to asymptomatic cases, but studies suggest a prevalence of 20-35% among alcohol consumers. With an estimated 8% of Americans suffering from alcoholism, this translates to approximately 26.6 million individuals at risk for AH, potentially resulting in 5.3-9.3 million AH cases (4).The management of AH remains a signi cant medical challenge, with steroids as the primary treatment. However, these treatments do not substantially reduce the long-term mortality rates (5-7). The risk of developing AH varies with the amount and duration of alcohol consumption, indicating the interplay of environmental, genetic, and sociodemographic factors in the disease development (7). Despite recent efforts to equalize healthcare access across racial and ethnic groups for chronic liver disease, the impact of these efforts on AH remains to be examined (8,9). Therefore, our study aims to analyze the mortality and morbidity of AH across racial groups and employ forecasting methods to project hospitalization trends up to 2028. This will aid ...