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Extrahepatic manifestations and healthcare expenditures of non-alcoholic fatty liver disease in the Medicare population

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Abstract

Background and aim

Non-alcoholic fatty liver disease (NAFLD) is a very common liver disease which has been associated with a number of the extrahepatic manifestations (EHMs) and healthcare expenditures. Our aim was to assess the presence and impact of these EHMs of NAFLD on mortality and healthcare expenditures.

Methods

Medicare beneficiaries (2005–2016) were included. ICD-9 and ICD-10 codes were used to identify patients with NAFLD and EHMs which included cardiovascular disease (CVD), hypertension (HTN), diabetes (DM), hyperlipidemia (HL), non-hepatocellular carcinoma (HCC) cancers, and others. Temporal trends among different groups were analyzed by join point regression model. Independent predictors of outcomes were evaluated in multiple generalized linear or logistic regression models.

Results

Among 30,908,679 Medicare beneficiaries (5% sample of Medicare data from 2005–2016), 1,980,950 (6.4%) had NAFLD diagnosis. From 2005 to 2016, the prevalence of NAFLD in the Medicare population increased at an average annual increase of 3.1%. The most common diseases associated with NAFLD were DM (86.3%), followed by HTN (85.2%), HL (79.8%), and CVD (35.8%). One-year mortality rate in NAFLD patients increased from 3.55 to 6.33 per 1000 from 2005 to 2016. One-year mortality was independently associated with diagnosis of HCC, cirrhosis, DM (outpatient), depression, dementia, lung disease, renal failure, thyroid disorder (inpatient), neurological disorder as well as non-HCC cancers.

Conclusion

NAFLD is associated with a number of EHMs that increases its mortality and increased healthcare expenditure.

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Abbreviations

NAFLD:

Non-alcoholic fatty liver disease

MS:

Metabolic syndrome

CVD:

Cardiovascular disease

CKD:

Chronic kidney disease

OSA:

Obstructive sleep apnea

EHM:

Extrahepatic manifestation

AAPC:

The average annual percent change

CCI:

Charlson Comorbidity Index

DM:

Diabetes mellitus

HCC:

Hepatocellular carcinoma

HL:

Hyperlipidemia

HTN:

Hypertension

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, USA

    Mehmet Sayiner, Tamoore Arshad, Freba Farhat & Zobair M. Younossi

  2. Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA, 22042, USA

    Mehmet Sayiner, Pegah Golabi, James Paik & Zobair M. Younossi

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  1. Mehmet Sayiner
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Correspondence to Zobair M. Younossi.

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Conflict of interest

Dr. Younossi is a consultant to BMS, Gilead, Intercept, NovoNordisk. Novartis, Terns, Merck, Viking, and Shinogi. All other authors have no conflict of interest to disclose. Mehmet Sayiner, Tamoore Arshad, Pegah Golabi, James Paik, Freba Farhat, Zobair M. Younossi read and approved the final version of the manuscript.

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Zobair M. Younossi is the guarantor of this work, and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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This article does not contain any studies with animals performed by any of the authors. This study was approved as “exempt” by the Inova Health Systems Internal Review Board located in Falls Church, VA, prior to the start of the study.

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Sayiner, M., Arshad, T., Golabi, P. et al. Extrahepatic manifestations and healthcare expenditures of non-alcoholic fatty liver disease in the Medicare population. Hepatol Int 14, 556–566 (2020). https://doi.org/10.1007/s12072-020-10038-w

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