Hospitalizations Due to Alcoholic Liver Disease Have Risen 12%

Hospitalizations related to alcoholic liver disease (ALD) rose 12% from 2008 to 2014 in the United States according to the results of a study presented at the 2018 American Association for the Study of Liver Diseases (AASLD) Liver Meeting in San Francisco, California.

The greatest increases in ALD-related hospitalizations were seen among women, Asians and Hispanics, and people 50 to 69 years of age, noted authors led by Farah Shirazi, MD, an internal medicine specialist at California Pacific Medical Center, San Francisco, CA.

“Alcoholic liver disease (ALD) accounts for up to 48% of cirrhosis-related deaths in the US and the major healthcare burden among ALD patients is attributed to inpatient hospitalizations,” wrote Shirazi and colleagues.

In order to better understand the epidemiology of alcoholic liver disease, the investigators analyzed the nation-wide trends in hospitalizations related to ALD, with a particular focus on trends that are sex-, race- or ethnicity-, and age-specific.

Shirazi’s team used data on ALD-related hospitalizations identified via ICD-9 codes from the 2008-2014 National Inpatient Sample. Investigators also used ICD-9 codes to identify cirrhosis and cirrhosis-related complications including ascites, hepatocellular carcinoma, hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome.

The research team found a total of 479,372 hospitalizations related to alcoholic liver disease, which represented an estimate of 2.33 million hospitalizations nationally. The mean age was 53.3 ±11.5 years and patients hospitalized were 72.0% male and 62.0% non-Hispanic white. Of the hospitalizations, 69.1% had cirrhosis, 2.6% hepatocellular carcinoma, 27.8% ascites, 2.3% spontaneous bacterial peritonitis, 16.6% hepatic encephalopathy, and 3.4% hepatorenal syndrome.

In total from 2008 to 2014, ALS-related hospitalizations increased by 12%, from 63,820, to 71,535. Among women, these hospitalizations increased by 20% compared to 9% among men (P <.01).

Among racial or ethnic groups, Asians had the greatest increase in ALD-related hospitalizations at 46%. Hispanics saw a 40% increase while hospitalizations increased 26% among non-Hispanic whites and roughly 32% among African Americans (P <.01).

When analyzing based on patient age group, the greatest increase was in patients 50 to 69 years of age (28%). Hospitalizations among people <50 years of age actually decreased by 5% from 2008 to 2014.

There were also significant increases in the rates of cirrhosis (16.1%, P <.01) and cirrhosis-related complications among patients with alcoholic liver disease (ascites 24%, HCC 35%, SBP 56%, HRS 27%, HE 28%, P <.01 for all). These increases reflect an ALD cohort with more severe disease, wrote the study authors.

The abstract, “Significant Increases in Alcoholic Liver Disease Related Hospitalizations in the United States By Sex, Race/Ethnicity, and Age: An Analysis of the 2008-2014 Nationwide Inpatient Sample” was presented last month at the American Association for the Study of Liver Diseases (AASLD; Liver Meeting) in San Francisco.