EPIDEMIOLOGIC TRENDS IN COMORBIDITY BURDEN AND HEALTHCARE RESOURCE UTILIZATION IN NONALCOHOLIC STEATOHEPATITIS (NASH): A LONGITUDINAL STUDY

Document Type

Conference Proceeding

Publication Date

10-1-2023

Publication Title

Hepatology

Abstract

Background: Nonalcoholic steatohepatitis (NASH) is on the rise globally, including the United States (US), and is linked to comorbidities, including diabetes mellitus (DM), cardiovascular disease (CVD), and chronic kidney disease (CKD). This has significant implications for healthcare resources including hospitalizations and undermines the quality of life. Despite extensive effort there is no FDA-approved treatment for NASH available as yet. In view of rising burden, we performed a longitudinal analysis to investigate trends of NASH related to hospitalizations and the impact of comorbidities on in-hospital mortality and on associated resources utilization. Methods: We used the National Readmission Database (2016-2020) which includes discharges for patients with and without repeat hospital visits in a year and those who have died in the hospital. We employed International Classification of Diseases (ICD)-10 codes to identify adult NASH patients. The linear trend of NASH diagnosis, hospitalizations, comorbidities, and mortality was tested using the Mantel-Haenszel linear trend test. The variables adjusted for in the regression models while computing adjusted hospitalization and readmission rates were: gender, age, Charlson Comorbidity Index score, median household income for patients' zip codes, hospital location/ bedside, and teaching status. We used Stata, version 14.2, to perform analyses considering 2-sided P<0.05 as statistically significant. Results: The analysis included 530,908 patients (mean age 62.15 y, females 61%). Incidence of NASH among hospitalized patients was noted to have increased from 27.82 to 43.44 per 10,000 patients from 2016 to 2020 (P<0.01). Comorbidities such as CKD (29.09% to 31.95%, P<0.01), liver cirrhosis (51.05% to 56.02%, P<0.01) showed increasing trends (Figure. 1). All-cause inpatient mortality in NASH adults increased from 3.92% to 4.53% (P<0.01), as well as palliative care utilization in this population (6.41% to 7.38%, P: 0.03). Liver transplantation rates did not significantly change (1.55% to 1.79%, P: 0.51). No decline was observed in 30 and 90-day readmission rates. Hepatic failure and cirrhosis (30.71%), infections (8.67%), NASH (5.84%), and non-variceal upper gastrointestinal bleeding (4.33%) were the leading causes of readmission. Mean hospitalization costs rose from $19,004 to $21,600 (P<0.01). Notably, comorbidities of DM and hepatocellular carcinoma in NASH did not exhibit an increase over the study period. Conclusion: Rising trend in hospitalizations noted in adult NASH population is concerning. The parallel rise in comorbidity burden, resource utilization, and mortality in hospitalized NASH patients is seen in the recent years while readmission trends exhibited a lack of decline. National strategies for effective management are needed to decrease the economic burden of NASH on the healthcare system.

Volume

78

First Page

S953

Last Page

S954

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