Trends in Alcoholic Hepatitis-related Hospitalizations, Financial Burden, and Mortality in the United States.
Trends in Alcoholic Hepatitis-related Hospitalizations, Financial Burden, and Mortality in the United States.
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DOI：
10.1097/mcg.0000000000000161
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发表时间：
2015-07
影响因子：
2.9
通讯作者：
Translational Research and Evolving Alcoholic Hepatitis Treatment Consortium
中科院分区：
文献类型：
--
作者：
Jinjuvadia R;Liangpunsakul S;Translational Research and Evolving Alcoholic Hepatitis Treatment Consortium
酒精性肝炎（AH）是酒精性肝病最常见的表现形式，它的发病率、死亡率和经济负担都很高。本研究的目的是评估酒精性肝炎住院的时间趋势，并评估其财务影响。使用了国家住院病人样本数据库（2002年至2010年），该数据库是卫生保健研究和质量局作为卫生保健成本和利用项目的一部分收集的。纳入年龄≥21岁的个体。初步诊断为AH的住院情况用ICD-9编码记录。全国住院人数估计数是根据NIS提供的样本权重得出的。使用简单线性回归方法评估死亡率和住院时间随时间的变化趋势。我们观察到，ahp相关住院总病例从2002年的249,884例（占总住院人数的0.66%）增加到2010年的326,403例（占总住院人数的0.83%）。总住院率的显著增加主要是由于继发诊断为AH的住院率上升（2002年为0.48%，2010年为0.67%）。大多数与AH相关的住院患者为男性。肝性脑病是继发诊断为AH的住院患者中最常见的入院诊断（2002年为8.9%，2010年为8.6%）。初次诊断为AH的住院死亡率显著下降，从2002年的10.07%降至2010年的5.76%（绝对风险降低4.3%）。2002年和2010年，初级诊断ahp相关的平均住院费用分别为27 124美元和46 264美元。经通货膨胀调整后，2010年每次住院的额外费用似乎比2002年增加了40.7%（与2002年相比，2010年每次住院的额外费用为11 044美元）。联邦（Medicare）或州（Medicaid）支持的健康保险计划是这些AH住院治疗的主要预期付款人（约25% - 29%）。尽管每次住院费用有所增加，但由于最初诊断为AH而住院的时间并没有随着时间的推移而大幅减少（2002年为6.7天，2010年为6.1天）。在研究期间，尽管住院死亡率有所下降，但ahp相关的住院率持续上升。观察到住院AH患者的医疗保健费用和利用率大幅增加。
Alcoholic hepatitis (AH) is the most florid manifestation of alcoholic liver disease which accounts for significant morbidity, mortality and financial burden. Aim of this study is to evaluate temporal trend of hospitalizations from alcoholic hepatitis and evaluate its financial impact. The National Inpatient Sample (NIS) databases (from 2002 to 2010) which are collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized. Individuals with age ≥ 21 years were included. The hospitalizations with primary diagnosis of AH were captured by ICD-9 codes. The national estimates of hospitalization were derived using sample weights provided by NIS. Simple linear regression method was used to assess trends in mortality and length of stay over time. We observed the increased in total cases of AH-related hospitalization from 249,884 (0.66% of total admission in 2002) to 326,403 (0.83% of total admission in 2010). The significant increase in the total admission rate was attributable mainly to the rise in inpatient hospitalization for secondary diagnosis of AH (0.48% in 2002 to 0.67% in 2010). Most of the AH related hospitalization were males. Hepatic encephalopathy was found to be the most common admitting diagnosis for individuals hospitalized with secondary diagnosis of AH (8.9% in 2002 and 8.6% in 2010). There was a significant decrease in inpatient mortality for primary diagnosis of AH from 10.07 % (in 2002) to 5.76% (in 2010) (absolute risk reduction: 4.3%). Average cost of hospitalization related to primary diagnosis of AH was $27,124 and $46,264 in 2002 and 2010, respectively. After adjusting for inflation, the additional cost of each hospitalization seemed to increase by 40.7% in 2010 compared to 2002 (additional cost per hospitalization $11,044 in 2010 compared to 2002). Federal (Medicare) or state (Medicaid) supported health insurance program are the main primary expected payers for these AH hospitalizations (~25% – 29%). Despite increase in cost per hospitalization, length of stay for hospitalization due to primary diagnosis of AH was not observed to decrease substantially over time (6.7 days in 2002 to 6.1 days in 2010). AH-related hospitalization continued to increase during the study period, despite the decreasing in the in-hospital mortality rate. Substantial increases in healthcare cost and utilization among hospitalized AH patients were observed.