Abstract
Background
Nonalcoholic fatty liver disease (NAFLD) is the fastest-growing chronic liver disease. However, little is known about NAFLD inpatient resource utilization and clinical outcomes.
Aims
The aim of this study was to quantify inpatient NAFLD encounters using patient-level data over time.
Methods
This was a retrospective analysis of de-identified data for NAFLD patients from the California Patient Discharge Database from 2006 to 2013. NAFLD patients were identified by ICD9 codes 571.40, 571.41, 571.49, 571.8, and 571.9.
Results
NAFLD patients (n = 91,558) were predominantly female (60%), 45–65 years old (44%), and white (53%). Inpatient encounters increased from 8153 in 2006 to 16,457 in 2013 and were associated with a 207% increase in charges ($686 million in 2006 to $1.42 billion in 2013) and average increase in charges of 9.8% per year adjusting for inflation. Comorbidities (obesity, diabetes, hyperlipidemia, cardiovascular disease, other cancer, and renal disease) increased significantly over time (all P < 0.05). From 2006 to 2011, there were 11,463 deaths (1849 for liver-related hospitalizations) (mean follow-up 4.00 ± 2.13 years). The most significant predictors of death were age > 75 (aHR 3.9, P < 0.0001), male gender (aHR 1.10, P < 0.0001), white race (aHR 1.2, P < 0.0001), decompensated cirrhosis (aHR 2.1, P < 0.0001), and cancer other than HCC (aHR 3.2, P < 0.0001). Within the liver-related hospitalization cohort, mortality predictors were similar, except for Hispanic race (aHR 0.92, P < 0.0096) and renal disease (aHR 1.50, P < 0.0001).
Conclusions
The number of NAFLD inpatient encounters increased significantly from 2006 to 2013, as did the inflation-adjusted inpatient charges. The most significant predictors of death were non-liver cancers (HR 3.11, P < 0.0001, CI 3.06–3.16) and age > 75 years (HR 3.94, P < 0.0001, HR 3.86–4.03).
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ALN contributed to study design, data collection, data analysis and interpretation, drafting of the manuscript. PN contributed to data collection, data interpretation, and review of the manuscript. ES contributed to data collection, data interpretation, and review of the manuscript. HP contributed to data collection, data interpretation, and review of the manuscript. YK contributed to data collection, data interpretation, and review of the manuscript. MN contributed to concept development, study design, data collection, data analysis and interpretation, and critical revision of the manuscript. In addition, the authors would like to acknowledge Donghak Jeong for his contribution to data collection and Linda Henry for her contribution in review of the manuscript.
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Haesuk Park: Research grants, Gilead, Proteus Digital Health. Yoona Kim: Consultant for Proteus Digital Health. Stocks: Gilead. Mindie Nguyen: Research grants, Gilead, Pfizer. Advisory board/Consultant, Gilead, Intercept. Alexander L. Nguyen, Pauline Nguyen, and Edward Sheen declare that they have no conflict of interest.
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Nguyen, A.L., Park, H., Nguyen, P. et al. Rising Inpatient Encounters and Economic Burden for Patients with Nonalcoholic Fatty Liver Disease in the USA. Dig Dis Sci 64, 698–707 (2019). https://doi.org/10.1007/s10620-018-5326-7
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DOI: https://doi.org/10.1007/s10620-018-5326-7