The impact of race and ethnicity on mortality and healthcare utilization in alcoholic hepatitis: a cross-sectional study

May, Folasade P.; Rolston, Vineet S.; Tapper, Elliot B.; Lakshmanan, Ashwini; Saab, Sammy; Sundaram, Vinay

doi:10.1186/s12876-016-0544-y

Cited by 22 publications

(18 citation statements)

References 39 publications

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“…This method has been used in previous studies to define decompensation. 28,32 Sensitivity analyses were also performed using alternate definitions of decompensation, based on ICD-9-CM codes for decompensation events (A. Baveno Stage 3/4; B. Ascites, hepatic encephalopathy, or bleeding esophageal varies; C. B + nonbleeding varices; D. C + hepatorenal syndrome or SBP). To explore whether cirrhosis-related procedures differed by gender, we also utilized validated ICD-9-CM procedure codes to identify paracentesis, thoracentesis, and transjugular intrahepatic portosystemic shunt (TIPS) procedures, and the procedure-based CCS to identify upper endoscopies.…”

Section: Variablesmentioning

confidence: 99%

Gender Differences Among Patients Hospitalized With Cirrhosis in the United States

Rubin

Sundaram

Lai

2020

Journal of Clinical Gastroenterology

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Background & Aims: Gender disparities exist in outcomes among patients with cirrhosis. We sought to evaluate the role of gender on hospital course and in-hospital outcomes in patients with cirrhosis to help better understand these disparities. Study:We analyzed data from the National Inpatient Sample (NIS), years 2009-2013, to identify patients with any diagnosis of cirrhosis. We calculated demographic and clinical characteristics by gender, as well as cirrhosis complications. Our primary outcome was inpatient mortality. We used logistic regression to associate baseline characteristics and cirrhosis complications with inpatient mortality.Results: Our cohort included 553,017 patients with cirrhosis admitted from 2009-2013. Women made up 39% of the cohort; median age was 57 with 66% non-Hispanic White. Women were more likely than men to have non-cirrhosis comorbidities, including diabetes and hypertension, but were less likely to have most cirrhosis complications, including ascites and variceal bleeding. Women were more likely than men to have acute bacterial infections (34.9% vs 28.2%, p < 0.001), and were less likely than men to die in the hospital on univariable (OR 0.88, 95% CI 0.86 -0.90, p < 0.001) and multivariable (OR 0.86, 95% CI 0.83 -0.88, p < 0.001) analysis. Conclusions:In patients hospitalized with cirrhosis, women have lower rates of hepatic decompensating events and higher rates of non-hepatic comorbidities and infections, resulting in lower in-hospital mortality. Understanding differences in indications for and disposition following hospitalization may help with the development of gender-specific cirrhosis management programs to improve long-term outcomes in women and men living with cirrhosis.

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Section: Variablesmentioning

confidence: 99%

Gender Differences Among Patients Hospitalized With Cirrhosis in the United States

Rubin

Sundaram

Lai

2020

Journal of Clinical Gastroenterology

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“…Cirrhosis and its decompensation (hepatorenal syndrome, jaundice, hepatic encephalopathy, ascites, variceal bleeding, and portal hypertension) were identified through ICD-9-CM codes (Supplementary Table 1). The Baveno IV classification has been extensively used and validated in the HCUP-NIS for the reliable identification of liver cirrhosis and assessment of its severity [28]. Finally, hospital characteristics that could impact outcomes were determined from the dataset and included hospital region (Northeast, South, Midwest and West), and hospital teaching status (rural, urban-nonteaching and urbanteaching).…”

Section: Study Population and Variablesmentioning

confidence: 99%

Prevalence, trends, outcomes, and disparities in hospitalizations for nonalcoholic fatty liver disease in the United States

Adejumo¹

2019

aog

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Background As the frequency of nonalcoholic fatty liver disease (NAFLD) continues to rise in the United States (US) community, more patients are hospitalized with NAFLD. However, data on the prevalence and outcomes of hospitalizations with NAFLD are lacking. We investigated the prevalence, trends and outcomes of NAFLD hospitalizations in the US. Methods Hospitalizations with NAFLD were identified in the National Inpatient Sample (2007-2014) by their ICD-9-CM codes, and the prevalence and trends over an 8-year period were calculated among different demographic groups. After excluding other causes of liver disease among the NAFLD cohorts (n=210,660), the impact of sex, race and region on outcomes (mortality, discharge disposition, length of stay [LOS], and cost) were computed using generalized estimating equations (SAS 9.4). Results Admissions with NAFLD tripled from 2007-2014 at an average rate of 79/100,000 hospitalizations/year (P<0.0001), with a larger rate of increase among males vs. females (83/100,000 vs. 75/100,000), Hispanics vs. Whites vs. Blacks (107/100,000 vs. 80/100,000 vs. 48/100,000), and government-insured or uninsured patients vs. privately-insured (94/100,000 vs. 74/100,000). Males had higher mortality, LOS, and cost than females. Blacks had longer LOS and poorer discharge destination than Whites; while Hispanics and Asians incurred higher cost than Whites. Uninsured patients had higher mortality, longer LOS, and poorer discharge disposition than the privately-insured. Conclusions Hospitalizations with NAFLD are rapidly increasing in the US, with a disproportionately higher burden among certain demographic groups. Measures are required to arrest this ominous trend and to eliminate the disparities in outcome among patients hospitalized with NAFLD.

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“…The main issue regards the long term management of the complications of portal hypertension. Previous published data have shown that Latinos are more likely to visit the ED and are more often admitted through the ED for alcohol related issues[ 22 ]. Similarly, our study showed that Latinos present more frequently at the ED and are hospitalized more often compared to Caucasians for alcohol related issues, but also present more frequently severe complications of portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of alcoholic hepatitis in latinos and caucasians: A single center experience

Pinon-Gutierrez¹,

Durbin‐Johnson²,

Halsted³

et al. 2017

WJG

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AIMTo study differences of presentation, management, and prognosis of alcoholic hepatitis in Latinos compared to Caucasians.METHODSWe retrospectively screened 876 charts of Caucasian and Latino patients who were evaluated at University of California Davis Medical Center between 1/1/2002-12/31/2014 with the diagnosis of alcoholic liver disease. We identified and collected data on 137 Caucasians and 64 Latinos who met criteria for alcoholic hepatitis, including chronic history of heavy alcohol use, at least one episode of jaundice with bilirubin ≥ 3.0 or coagulopathy, new onset of liver decompensation or acute liver decompensation in known cirrhosis within 12 wk of last drink.RESULTSThe mean age at presentation of alcoholic hepatitis was not significantly different between Latinos and Caucasians. There was significant lower rate of overall substance abuse in Caucasians compared to Latinos and Latinos had a higher rate of methamphetamine abuse (12.5% vs 0.7%) compared to Caucasians. Latinos had a higher mean number of hospitalizations (5.3 ± 5.6 vs 2.7 ± 2.7, P = 0.001) and mean Emergency Department visits (9.5 ± 10.8 vs 4.5 ± 4.1, P = 0.017) for alcohol related issues and complications compared to Caucasians. There was significantly higher rate of complications of portal hypertension including gastrointestinal bleeding (79.7% vs 45.3%, P < 0.001), spontaneous bacterial peritonitis (26.6% vs 9.5%, P = 0.003), and encephalopathy (81.2% vs 55.5%, P = 0.001) in Latinos compared to Caucasians.CONCLUSIONLatinos have significant higher rates of utilization of acute care services for manifestations alcoholic hepatitis and complications suggesting poor access to outpatient care.

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The impact of race and ethnicity on mortality and healthcare utilization in alcoholic hepatitis: a cross-sectional study

Cited by 22 publications

References 39 publications

Gender Differences Among Patients Hospitalized With Cirrhosis in the United States

Gender Differences Among Patients Hospitalized With Cirrhosis in the United States

Prevalence, trends, outcomes, and disparities in hospitalizations for nonalcoholic fatty liver disease in the United States

Clinical features of alcoholic hepatitis in latinos and caucasians: A single center experience

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