Skip to main content

Advertisement

SpringerLink
Log in

A Nationwide Study of Inpatient Admissions, Mortality, and Costs for Patients with Cirrhosis from 2005 to 2015 in the USA

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

Liver cirrhosis is a substantial health burden in the USA, but population-based data regarding the trend and medical expenditure are limited and outdated. We investigated the trends of inpatient admissions, costs, and inpatient mortality from 2005 to 2015 among cirrhotic patients.

Methods

A retrospective analysis was conducted using the National Inpatient Sample database. We adjusted the costs to 2015 US dollars using a 3% inflation rate. National estimates of admissions were determined using discharge weights.

Results

We identified 1,627,348 admissions in cirrhotic patients between 2005 and 2015. From 2005 to 2015, the number of weighted admissions in cirrhotic patients almost doubled (from 505,032 to 961,650) and the total annual hospitalization cost in this population increased three times (from 5.8 to 16.3 billion US dollars). Notably, admission rates varied by liver disease etiology, decreasing from 2005 to 2015 among patients with hepatitis C virus (HCV)-related cirrhosis while increasing (almost tripled) among patients with nonalcoholic fatty liver disease (NAFLD)-related cirrhosis. The annual inpatient mortality rate per 1000 admissions overall decreased from 63.8 to 58.2 between 2005 and 2015 except for NAFLD (27.2 to 35.8) (P < 0.001).

Conclusions

Rates and costs of admissions in cirrhotic patients have increased substantially between 2005 and 2015 in the USA, but varied by liver disease etiology, with decreasing rate for HCV-associated cirrhosis and for HBV-associated cirrhosis but increasing for NAFLD-associated cirrhosis. Inpatient mortality also increased by one-third for NAFLD, while it decreased for other diseases. Cost also varied by etiology and lower for HCV-associated cirrhosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nusrat S, Khan MS, Fazili J, Madhoun MF. Cirrhosis and its complications: evidence based treatment. World J Gastroenterol. 2014;20:5442–5460.

    Article  CAS  Google Scholar 

  2. Asrani SK, Larson JJ, Yawn B, Therneau TM, Kim WR. Underestimation of liver-related mortality in the United States. Gastroenterology. 2013;145(375–382):e372.

    Google Scholar 

  3. Mokdad AA, Lopez AD, Shahraz S, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Med. 2014;12:145.

    Article  Google Scholar 

  4. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. Jama. 2013;310:591–608.

    Article  CAS  Google Scholar 

  5. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases. Gastroenterology. 2009;136:376–386.

    Article  Google Scholar 

  6. Kim D, Li AA, Perumpail BJ, et al. Changing trends in etiology- and ethnicity-based annual mortality rates of cirrhosis and hepatocellular carcinoma in the United States. Hepatology (Baltimore, Md.). 2018.

  7. Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States 1999–2016: observational study. BMJ (Clinical research ed.). 2018;362:k2817.

    Article  Google Scholar 

  8. Kim D, Cholankeril G, Li AA, et al. Trends in hospitalizations for chronic liver disease-related liver failure in the United States, 2005–2014. Liver Int Off J Int Assoc Study Liver. 2019.

  9. Kim D, Li AA, Perumpail BJ, et al. Changing trends in etiology-based and ethnicity-based annual mortality rates of cirrhosis and hepatocellular carcinoma in the United States. Hepatology (Baltimore, Md.). 2019;69:1064–1074.

    Article  Google Scholar 

  10. Goldberg D, Ditah IC, Saeian K, et al. Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Gastroenterology. 2017;152:e1091.

    Article  Google Scholar 

  11. HCUP Nationwide Inpatient Sample (NIS). Healthcare cost and utilization project (HCUP). City 2011.

  12. Overview of the National (Nationwide) Inpatient Sample (NIS). Available at: https://www.hcup-us.ahrq.gov/nisoverview.jsp (2015). Accessed 12.03.2018.

  13. Allen AM, Kim WR, Moriarty JP, Shah ND, Larson JJ, Kamath PS. Time trends in the health care burden and mortality of acute on chronic liver failure in the United States. Hepatology (Baltimore, Md.). 2016;64:2165–2172.

    Article  Google Scholar 

  14. Lok AS, McMahon BJ, Brown RS Jr, et al. Antiviral therapy for chronic hepatitis B viral infection in adults: a systematic review and meta-analysis. Hepatology (Baltimore, Md.). 2016;63:284–306.

    Article  CAS  Google Scholar 

  15. Lin D, Yang HI, Nguyen N, et al. Reduction of chronic hepatitis B-related hepatocellular carcinoma with antiviral therapy, including low risk patients. Alimentary pharmacology & therapeutics. 2016;44:846–855.

    Article  CAS  Google Scholar 

  16. Rosenberg ES, Rosenthal EM, Hall EW, et al. Prevalence of hepatitis C virus infection in US states and the district of Columbia, 2013 to 2016. Jama Netw Open. 2018;1:e186371.

    Article  Google Scholar 

  17. Cohen C, Holmberg SD, McMahon BJ, et al. Is chronic hepatitis B being undertreated in the United States? J Viral Hepat.. 2011;18:377–383.

    Article  CAS  Google Scholar 

  18. Spradling PR, Xing J, Rupp LB, et al. Infrequent clinical assessment of chronic hepatitis B patients in United States general healthcare settings. Clin Infect Dis Off Publ Infect Dis Soc Am. 2016;63:1205–1208.

    CAS  Google Scholar 

  19. Nguyen AL, Park H, Nguyen P, Sheen E, Kim YA, Nguyen MH. Rising inpatient encounters and economic burden for patients with nonalcoholic fatty liver disease in the USA. Dig Dis Sci. 2019;64:698–707. https://doi.org/10.1007/s10620-018-5326-7

    Article  CAS  PubMed  Google Scholar 

  20. Raetzman SO, Hines AL, Barrett ML, Karaca Z. Hospital stays in medicare advantage plans versus the traditional medicare fee-for-service program, 2013: statistical Brief#198. ed. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs, City; Agency for Healthcare Research and Quality (US);2006.

  21. Kanwal F, Tansel A, Kramer JR, Feng H, Asch SM, El-Serag HB. Trends in 30-day and 1-year mortality among patients hospitalized with cirrhosis from 2004 to 2013. Am J Gastroenterol. 2017;112:1287–1297.

    Article  Google Scholar 

  22. Golabi P, Bush H, Stepanova M, et al. Liver transplantation (LT) for cryptogenic cirrhosis (CC) and nonalcoholic steatohepatitis (NASH) cirrhosis: data from the scientific registry of transplant recipients (SRTR): 1994 to 2016. Medicine. 2018;97:e11518.

    Article  Google Scholar 

  23. Thuluvath PJ, Kantsevoy S, Thuluvath AJ, Savva Y. Is cryptogenic cirrhosis different from NASH cirrhosis? J Hepatol. 2018;68:519–525.

    Article  Google Scholar 

  24. Mellinger JL, Shedden K, Winder GS, et al. The high burden of alcoholic cirrhosis in privately insured persons in the United States. Hepatology (Baltimore, Md.). 2018;68:872–882.

    Article  Google Scholar 

  25. Khera R, Angraal S, Couch T, et al. Adherence to methodological standards in research using the national inpatient sample. Jama. 2017;318:2011–2018.

    Article  Google Scholar 

Download references

Acknowledgments

This research used the NIS dataset provided by HCUP. We thank the HCUP Data Partners that contributed to HCUP. The state organizations were listed here: www.hcup-us.aORq.gov/hcupdatapartners.jsp.

Funding

None to disclose.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA

    Biyao Zou, Yee Hui Yeo, Donghak Jeong, Edward Sheen, Dong Hyun Lee, Linda Henry, Gabriel Garcia, Ramsey Cheung & Mindie H. Nguyen

  2. Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA

    Haesuk Park

  3. Good Gang An Hospital, Busan, South Korea

    Dong Hyun Lee

  4. Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Erik Ingelsson

  5. Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA

    Erik Ingelsson

  6. Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

    Ramsey Cheung

Authors
  1. Biyao Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yee Hui Yeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donghak Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haesuk Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edward Sheen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dong Hyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Linda Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gabriel Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Erik Ingelsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ramsey Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mindie H. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MHN and BZ had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. MHN was involved in study concept, supervision, and guarantor of the article. BZ, YHY, EI, RC, and MHN were involved in study design. BZ, YHY, LH, RC, and MHN contributed to drafting of the manuscript. BZ, YHY, DJ, and MHN helped in data analysis. YHY, BZ, and MHN contributed to data collection. All the authors were involved in data interpretation, review, and revision of the manuscript, and all the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Mindie H. Nguyen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 737 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zou, B., Yeo, Y.H., Jeong, D. et al. A Nationwide Study of Inpatient Admissions, Mortality, and Costs for Patients with Cirrhosis from 2005 to 2015 in the USA. Dig Dis Sci 65, 1520–1528 (2020). https://doi.org/10.1007/s10620-019-05869-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-019-05869-z

Keywords

Search

Navigation