The high burden of alcoholic cirrhosis in privately insured persons in the United States
The high burden of alcoholic cirrhosis in privately insured persons in the United States
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DOI：
10.1002/hep.29887
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发表时间：
2018-09-01
期刊：
影响因子：
13.5
通讯作者：
Lok, Anna S. F.
中科院分区：
文献类型：
--
作者：
Mellinger, Jessica L.;Shedden, Kerby;Lok, Anna S. F.
酒精性肝硬变(AC)是美国肝脏相关发病率和死亡率的主要原因。在美国，酒精使用障碍率的上升可能会导致更多的酒精性肝病。我们的目的是确定AC在美国私人参保人中的流行率、医疗保健使用和费用。我们收集了在Truven MarketScan商业索赔和遭遇数据库中登记的18岁-患有AC(由国际疾病分类第九版和第十版中的代码识别)的数据(2009年至2015年)。我们确定了每年的流行率，加权到全国雇主赞助的私人保险人口。使用竞争性风险分析，我们估计了门脉高压并发症的事件发生率，并估计了AC与费用以及入院和再入院之间的关系。2015年，294,215人患有肝硬变，105,871人(36%)患有AC。确诊为AC的平均年龄为53.5岁，其中32%为女性。在被询问的7年中，估计的全国肝硬变患病率从0.19%上升到0.27%(P<；0.001)，AC从0.07%上升到0.10%(P<；0.001)。与非AC参与者相比，AC参与者在确诊时更有可能出现门脉高压并发症，以及更高的年度肝硬变和酒精相关住院人数(每100名参与者中有25名超额肝硬变住院和6.3名超额酒精相关入院)以及各种原因的再入院。确诊后第一年，AC患者的人均费用几乎是非AC患者的两倍(44,835美元比23,319美元)。结论：在一个具有全国代表性的私人参保人队列中，AC参保者在发病时病情严重，入院和再次入院的频率更高，人均医疗费用几乎是非AC参保者的两倍。(2018年《肝病》)。
Alcoholic cirrhosis (AC) is a major cause of liver-related morbidity and mortality in the United States. Rising rates of alcohol use disorders in the United States will likely result in more alcoholic liver disease. Our aim was to determine the prevalence, health care use, and costs of AC among privately insured persons in the United States. We collected data from persons aged 18-64 with AC (identified by codes from the International Classification of Diseases, Ninth and Tenth Revisions) enrolled in the Truven MarketScan Commercial Claims and Encounters database (2009-2015). We determined yearly prevalence, weighted to the national employer-sponsored, privately insured population. Using competing risk analysis, we estimated event rates for portal hypertensive complications and estimated the association between AC and costs as well as admissions and readmissions. In 2015, 294,215 people had cirrhosis and 105,871 (36%) had AC. Mean age at AC diagnosis was 53.5 years, and 32% were women. Over the 7 years queried, estimated national cirrhosis prevalence rose from 0.19% to 0.27% (P < 0.001) and for AC from 0.07% to 0.10% (P < 0.001). Compared to non-AC, AC enrollees were significantly more likely to have portal hypertensive complications at diagnosis and higher yearly cirrhosis and alcohol-related admissions (25 excess cirrhosis admissions and 6.3 excess alcohol-related admissions per 100 enrollees) as well as all-cause readmissions. Per-person costs in the first year after diagnosis nearly doubled for AC versus non-AC persons (US$ 44,835 versus 23,319). Conclusion: In a nationally representative cohort of privately insured persons, AC enrollees were disproportionately sicker at presentation, were admitted and readmitted more often, and incurred nearly double the per-person health care costs compared to those with non-AC. (Hepatology 2018).