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Race/Ethnicity and Insurance-Specific Disparities in In-Hospital Mortality Among Adults with Primary Biliary Cholangitis: Analysis of 2007–2014 National Inpatient Sample

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Abstract

Background

Primary biliary cholangitis (PBC) is a progressive autoimmune liver disease that can result in cirrhosis and end-stage liver disease.

Aims

We aim to evaluate hospitalization burden and in-hospital mortality among PBC patients in the USA.

Methods

Using data from the Nationwide Inpatient Sample from 2007 to 2014, hospitalizations among US adults with PBC were stratified by sex, age, and race/ethnicity. Overall in-hospital mortality was stratified by these variables and adjusted multivariate regression models evaluated for predictors of in-hospital mortality.

Results

From 2007 to 2014, there were 18,279 hospitalizations among adults with PBC (15.0% male, mean age 63.8 years, 41.3% cirrhosis). Among non-Hispanic whites, the proportion of total PBC hospitalizations increased from 57.8% in 2007 to 71.2% in 2014, compared to 4.1–6.3% for African-Americans, 8.6–10.9% for Hispanics, and 1.7–2.8% for Asians (p < 0.001 for all). While overall in-hospital mortality was low (4.2%), increasing age was associated with higher odds of in-hospital mortality (OR: 1.02, 95% CI 1.01–1.03, p < 0.001). Compared to non-Hispanic white PBC patients, higher in-hospital mortality was observed in African-American PBC patients (OR: 1.40, 95% CI 1.16–2.03, p < 0.05). Compared to patients with private/commercial insurance, significantly higher odds of in-hospital mortality were observed in patients with Medicaid insurance (OR 1.42, 95% CI 1.00–1.99, p < 0.05).

Conclusion

In summary, among adults with PBC hospitalized in the USA from 2007 to 2014, the overall number of hospitalizations is increasing. Significant disparities in in-hospital mortality were observed; African-Americans with PBC and Medicaid patients with PBC have disproportionately higher odds of in-hospital mortality.

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Abbreviations

AHRQ:

Agency for healthcare research and quality

ALD:

Alcoholic liver disease

APR-DRG:

All patient-refined diagnosis-related group

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HRS:

Hepatorenal syndrome

NAFLD:

Nonalcoholic fatty liver disease

NIS:

Nationwide Inpatient Sample

PBC:

Primary biliary cholangitis

UDCA:

Ursodeoxycholic acid

MELD:

Model for end-stage liver disease

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Funding

No funding support was provided for this study. Robert Wong is supported by an AASLD Foundation Clinical and Translational Research Award in Liver Diseases.

Author information

Authors and Affiliations

  1. Department of Medicine, California Pacific Medical Center, 2351 Clay Street, San Francisco, CA, 94115, USA

    Artin Galoosian

  2. Department of Medicine, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA

    Courtney Hanlon

  3. Department of Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA

    Courtney Hanlon

  4. Division of Gastroenterology and Hepatology, University of California, San Francisco, CA, USA

    Michele Tana

  5. Division of Gastroenterology and Hepatology, UCSF—Zuckerberg San Francisco General Hospital, San Francisco General Hospital, 1001 Potrero Ave, NH-3D, San Francisco, CA, 94110, USA

    Michele Tana

  6. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Palo Alto, CA, 94304, USA

    Ramsey Cheung

  7. Division of Gastroenterology and Hepatology, Alameda Health System, 1411 East 31st Street, Highland Hospital—Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA

    Robert J. Wong

Authors
  1. Artin Galoosian
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  2. Courtney Hanlon
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  3. Michele Tana
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  4. Ramsey Cheung
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  5. Robert J. Wong
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Contributions

AG contributed to the study concept and design, analysis and interpretation of data, writing of the manuscript, critical revision of the manuscript, study supervision. CH contributed to the analysis and interpretation of data, writing of the manuscript, critical revision of the manuscript. MT contributed to the analysis and interpretation of data, critical revision of the manuscript. RC contributed to the analysis and interpretation of data, critical revision of the manuscript. RW contributed to the study concept and design, analysis and interpretation of data, critical revision of the manuscript, study supervision.

Corresponding author

Correspondence to Robert J. Wong.

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Conflict of interest

Artin Galoosian, Courtney Hanlon, Michele Tana, Benny Liu, Taft Bhuket: None. Ramsey Cheung: research grants: Gilead Sciences. Robert Wong: Advisory board, consultant, speaker’s bureau, and research grants: Gilead Sciences; research grant: Abbvie; speaker’s bureau: Salix.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this retrospective observational cohort study, informed consent was not required.

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Galoosian, A., Hanlon, C., Tana, M. et al. Race/Ethnicity and Insurance-Specific Disparities in In-Hospital Mortality Among Adults with Primary Biliary Cholangitis: Analysis of 2007–2014 National Inpatient Sample. Dig Dis Sci 65, 406–415 (2020). https://doi.org/10.1007/s10620-019-05809-x

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  • DOI: https://doi.org/10.1007/s10620-019-05809-x

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