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Rising Inpatient Encounters and Economic Burden for Patients with Nonalcoholic Fatty Liver Disease in the USA

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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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Acknowledgments

We acknowledge that no funding was received and have no financial disclosures.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, John H. Stroger Jr. Hospital of Cook County, 1900 W. Polk St. 14th Floor, Chicago, IL, 60612, USA

    Alexander L. Nguyen

  2. College of Pharmacy, University of Florida, HPNP Room 3325, 1225 Center Dr, Gainesville, FL, 32601, USA

    Haesuk Park

  3. Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Dr A160 MC 5309, Stanford, CA, 94305, USA

    Pauline Nguyen, Edward Sheen, Yoona A. Kim & Mindie H. Nguyen

Authors
  1. Alexander L. Nguyen
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  2. Haesuk Park
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  3. Pauline Nguyen
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  4. Edward Sheen
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  5. Yoona A. Kim
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  6. Mindie H. Nguyen
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Contributions

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.

Corresponding author

Correspondence to Mindie H. Nguyen.

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Conflict of interest

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

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