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©The Author(s) 2022.
World J Gastroenterol. Sep 14, 2022; 28(34): 5036-5046
Published online Sep 14, 2022. doi: 10.3748/wjg.v28.i34.5036
Published online Sep 14, 2022. doi: 10.3748/wjg.v28.i34.5036
Table 1 Diagnosis to be included International Classification of Diseases-9 and its correspondent International Classification of Diseases-10
| ICD-9 | Correspondent ICD-10 |
| 571.0 alcoholic fatty liver | K.70 alcoholic fatty liver |
| 571.1 acute alcoholic hepatitis | K.70.11 alcoholic hepatitis with ascites |
| K.70.10 alcoholic hepatitis without ascites | |
| 571.2 alcoholic cirrhosis of liver | Correspondent ICD-10 found |
| 571.3 alcoholic liver damage, unspecified | K70.40 alcoholic hepatic failure without coma |
| K70.41 alcoholic hepatic failure with coma | |
| K70.9 alcoholic liver disease, unspecified |
Table 2 Trend of alcoholic hepatitis-related hospitalization 2011 to 2017
| 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | P | |
| Total admission, n | 38590733 | 36484846 | 35597792 | 35358818 | 35769942 | 35675421 | 35798453 | |
| AH-related admission, n (%) | 281506 (0.7) | 274365 (0.8) | 278580 (0.8) | 291435 (0.8) | 308765 (0.9) | 313235 (0.9) | 324050 (0.9) | < 0.001 |
| Admission when primary admission diagnosis is AH, n (%) | 47140 (0.1) | 45710 (0.1) | 46715 (0.1) | 48395 (0.1) | 54955 (0.2) | 66170 (0.2) | 71290 (0.2) | < 0.001 |
Table 3 Summary statistics of demographic of hospitalized alcoholic hepatitis patients, 2011 to 2017
| Characteristic | AH-related admission | P1 | |||||||
| 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | Overall | Between-group | |
| n | 281506 | 274365 | 278580 | 291435 | 308765 | 313235 | 324050 | ||
| Age in years at admission [median (Q1, Q3)] | 54.0 (46.0, 61.0) | 54.0 (46.0, 61.0) | 54.0 (46.0, 62.0) | 54.0 (46.0, 62.0) | 54.0 (46.0, 62.0) | 54.0 (46.0, 62.0) | 55.0 (46.0, 62.0) | < 0.001 | |
| Age group (yr) | < 0.001 | ||||||||
| < 25, n (%) | 1545 (0.5) | 1215 (0.4) | 1135 (0.4) | 1295 (0.4) | 1320 (0.4) | 1635 (0.5) | 1535 (0.5) | 0.011 | |
| 25-44, n (%) | 57738 (20.5) | 57040 (20.8) | 58155 (20.9) | 61335 (21.0) | 66670 (21.6) | 69165 (22.1) | 70935 (21.9) | < 0.001 | |
| 45-64, n (%) | 170876 (60.7) | 166030 (60.5) | 167810 (60.2) | 174765 (60.0) | 181845 (58.9) | 182905 (58.4) | 187350 (57.8) | < 0.001 | |
| ≥65, n (%) | 51348 (18.2) | 50080 (18.3) | 51480 (18.5) | 54040 (18.5) | 58930 (19.1) | 59530 (19.0) | 64230 (19.8) | < 0.001 | |
| Gender | < 0.001 | ||||||||
| Male, n (%) | 198491 (70.5) | 195350 (71.2) | 196820 (70.7) | 203735 (69.9) | 216650 (70.2) | 218295 (69.7) | 227080 (70.1) | < 0.001 | |
| Female, n (%) | 83016 (29.5) | 79000 (28.8) | 81725 (29.3) | 87615 (30.1) | 92075 (29.8) | 94810 (30.3) | 96965 (29.9) | < 0.001 | |
| Missing, n (%) | 0 (0.0) | 15 (0.0) | 35 (0.0) | 85 (0.0) | 40 (0.0) | 130 (0.0) | 5 (0.0) | ||
| Race | < 0.001 | ||||||||
| White, n (%) | 178031 (63.2) | 180550 (65.8) | 183125 (65.7) | 193560 (66.4) | 202205 (65.5) | 207155 (66.1) | 214760 (66.3) | < 0.001 | |
| Black, n (%) | 27402.8 (9.7) | 27045 (9.9) | 26625 (9.6) | 27630 (9.5) | 29145 (9.4) | 28025 (8.9) | 29290 (9.0) | < 0.001 | |
| Hispanic, n (%) | 37280 (13.2) | 36670 (13.4) | 38575 (13.8) | 38905 (13.3) | 43390 (14.1) | 45870 (14.6) | 49135 (15.2) | < 0.001 | |
| Asian or Pacific Islander, n (%) | 2235 (0.8) | 2370 (0.9) | 2680 (1.0) | 2855 (1.0) | 3565 (1.2) | 3520 (1.1) | 3840 (1.2) | < 0.001 | |
| Native American, n (%) | 5056 (1.8) | 5985 (2.2) | 5720 (2.1) | 5910 (2.0) | 6725 (2.2) | 7140 (2.3) | 7565 (2.3) | < 0.001 | |
| Other, n (%) | 7134 (2.5) | 7760 (2.8) | 6940 (2.5) | 7785 (2.7) | 7780 (2.5) | 8305 (2.7) | 9085 (2.8) | 0.030 | |
| Missing, n (%) | 24368.5 (8.7) | 13985 (5.1) | 14915 (5.4) | 14790 (5.1) | 15955 (5.2) | 13220 (4.2) | 10375 (3.2) | ||
| Median household income national quartile for patient ZIP code | < 0.001 | ||||||||
| $1-$38999, n (%) | 79993 (28.4) | 83510 (30.4) | 80530 (28.9) | 85525 (29.3) | 95660 (31.0) | 94940 (30.3) | 95785 (29.6) | < 0.001 | |
| $39000-$47999, n (%) | 69137 (24.6) | 66095 (24.1) | 71125 (25.5) | 76895 (26.4) | 72860 (23.6) | 77800 (24.8) | 83130 (25.7) | < 0.001 | |
| $48000-$62999, n (%) | 68313 (24.3) | 62360 (22.7) | 65010 (23.3) | 65695 (22.5) | 72025 (23.3) | 73690 (23.5) | 75805 (23.4) | < 0.001 | |
| $63000 or more, n (%) | 56576 (20.1) | 53795 (19.6) | 53035 (19.0) | 54360 (18.7) | 59515 (19.3) | 58905 (18.8) | 60560 (18.7) | < 0.001 | |
| Missing, n (%) | 7487.7 (2.7) | 8605 (3.1) | 8880 (3.2) | 8960 (3.1) | 8705 (2.8) | 7900 (2.5) | 8770 (2.7) | ||
| Primary expected payer | < 0.001 | ||||||||
| Medicare, n (%) | 82774 (29.4) | 81905 (29.9) | 85335 (30.6) | 88860 (30.5) | 93460 (30.3) | 94160 (30.1) | 99510 (30.7) | < 0.001 | |
| Medicaid, n (%) | 60601 (21.5) | 61975 (22.6) | 62490 (22.4) | 86040 (29.5) | 96230 (31.2) | 100255 (32.0) | 105305 (32.5) | < 0.001 | |
| Private including HMO, n (%) | 71261 (25.3) | 65885 (24.0) | 65405 (23.5) | 70445 (24.2) | 76095 (24.6) | 75795 (24.2) | 76200 (23.5) | < 0.001 | |
| Self-pay, n (%) | 45272 (16.1) | 43865 (16.0) | 42785 (15.4) | 31705 (10.9) | 28095 (9.1) | 27930 (8.9) | 28890 (8.9) | < 0.001 | |
| No charge, n (%) | 4980.6 (1.8) | 3455 (1.3) | 5330 (1.9) | 3235 (1.1) | 3195 (1.0) | 2995 (1.0) | 2610 (0.8) | < 0.001 | |
| Other, n (%) | 15296.9 (5.4) | 16515 (6.0) | 16670 (6.0) | 10555 (3.6) | 11150 (3.6) | 11625 (3.7) | 10805 (3.3) | < 0.001 | |
| Missing, n (%) | 1320 (0.5) | 765 (0.3) | 565 (0.2) | 595 (0.2) | 540 (0.2) | 475 (0.2) | 730 (0.2) | ||
| Bed size of hospital | < 0.001 | ||||||||
| Small, n (%) | 32567 (11.6) | 36820 (13.4) | 37640 (13.5) | 54105 (18.6) | 54870 (17.8) | 57875 (18.5) | 64035 (19.8) | < 0.001 | |
| Medium, n (%) | 73628 (26.2) | 77055 (28.1) | 76680 (27.5) | 86355 (29.6) | 94260 (30.5) | 91795 (29.3) | 97445 (30.1) | < 0.001 | |
| Large, n (%) | 175312 (62.3) | 160490 (58.5) | 164260 (59.0) | 150975 (51.8) | 159635 (51.7) | 163565 (52.2) | 162570 (50.2) | < 0.001 | |
| Region of hospital | 0.001 | ||||||||
| Northeast, n (%) | 53252 (18.9) | 51120 (18.6) | 51855 (18.6) | 53795 (18.5) | 56100 (18.2) | 57590 (18.4) | 59600 (18.4) | 0.16 | |
| Midwest, n (%) | 61095 (21.7) | 59575 (21.7) | 60330 (21.7) | 64160 (22.0) | 67170 (21.8) | 68655 (21.9) | 72150 (22.3) | 0.42 | |
| South, n (%) | 95441 (33.9) | 94365 (34.4) | 95705 (34.4) | 98035 (33.6) | 105260 (34.1) | 105730 (33.8) | 108555 (33.5) | 0.017 | |
| West, n (%) | 71718 (25.5) | 69305 (25.3) | 70690 (25.4) | 75445 (25.9) | 80235 (26.0) | 81260 (25.9) | 83745 (25.8) | 0.046 | |
| Location teaching status of hospital | < 0.001 | ||||||||
| Rural, n (%) | 28721 (10.2) | 27135 (9.9) | 26909.9 (9.7) | 23195 (8.0) | 23990 (7.8) | 24250 (7.7) | 25035 (7.7) | < 0.001 | |
| Urban non-teaching, n (%) | 127976 (45.5) | 113625 (41.4) | 112610 (40.4) | 84150 (28.9) | 88965 (28.8) | 87650 (28.0) | 77930 (24.0) | < 0.001 | |
| Urban teaching, n (%) | 124809 (44.3) | 133605 (48.7) | 139060 (49.9) | 184090 (63.2) | 195810 (63.4) | 201335 (64.3) | 221085 (68.2) | < 0.001 | |
Table 4 Mortality-related risk factors in alcoholic hepatitis patients who expired while hospitalized, 2011 to 2017
| 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | P | |
| n | 15002 | 14845 | 15310 | 15885 | 16385 | 17435 | 17785 | |
| Sepsis, n (%) | 1111 (7.4) | 950 (6.4) | 980 (6.4) | 1170 (7.4) | 2850 (17.4) | 8145 (46.7) | 8595 (48.3) | < 0.001 |
| GI hemorrhage, n (%) | 2582 (17.2) | 2755 (18.6) | 2715 (17.7) | 3230 (20.3) | 3025 (18.5) | 3355 (19.2) | 3395 (19.1) | 0.042 |
| Acute renal failure, n (%) | 8941 (59.6) | 9450 (63.7) | 9780 (63.9) | 10485 (66.0) | 11265 (68.8) | 12325 (70.7) | 12825 (72.1) | < 0.001 |
Table 5 Multivariable logistic regression on death during hospitalization among alcoholic hepatitis-related admission1 from 2011 to 2017
| Variables | Levels | Odds ratio | ||
| Estimate | 95% confidence interval | P after Bonferroni correction2 | ||
| Age groups (yr) | < 25 | 1.0 | Reference | |
| 25-44 | 1.89 | 1.28-2.79 | 0.039 | |
| 45-64 | 2.85 | 1.93-4.21 | < 0.0001 | |
| 65/65+ | 3.55 | 2.4-5.25 | < 0.0001 | |
| Sex | Male | Reference | ||
| Female | 1.13 | 1.09-1.17 | < 0.0001 | |
| Race | White | 1.0 | Reference | |
| Black | 0.82 | 0.77-0.86 | < 0.0001 | |
| Hispanic | 0.94 | 0.9-0.98 | 0.20 | |
| Asian or Pacific Islander | 0.92 | 0.8-1.07 | 1.00 | |
| Native American | 1.04 | 0.94-1.15 | 1.00 | |
| Other | 1.12 | 1.02-1.22 | 0.36 | |
| Primary expected payer | Medicare | 1.0 | Reference | |
| Medicaid | 1.12 | 1.07-1.18 | 0.00020 | |
| Private including HMO | 1.11 | 1.06-1.17 | 0.00025 | |
| Self-pay | 1.37 | 1.29-1.45 | < 0.0001 | |
| No charge | 0.92 | 0.78-1.09 | 1.00 | |
| Other | 1.45 | 1.34-1.57 | < 0.0001 | |
| Median household income national quartile for patient ZIP code | $1-$38999 | 1.0 | Reference | |
| $39000-$47999 | 0.98 | 0.94-1.02 | 1.00 | |
| $48000-$62999 | 0.95 | 0.92-1 | 0.84 | |
| $63000 or more | 0.9 | 0.86-0.94 | 0.00021 | |
| Bed size of hospital | Small | 1.0 | Reference | |
| Medium | 1.2 | 1.14-1.26 | < 0.0001 | |
| Large | 1.3 | 1.25-1.37 | < 0.0001 | |
| Region of hospital | Northeast | 1.0 | Reference | |
| Midwest | 0.91 | 0.87-0.96 | 0.0062 | |
| South | 1 | 0.96-1.05 | 1.00 | |
| West | 1.08 | 1.03-1.14 | 0.023 | |
| Location/teaching status of hospital | Rural | 1.0 | Reference | |
| Urban non-teaching | 1.03 | 0.97-1.1 | 1.00 | |
| Urban teaching | 1.08 | 1.02-1.15 | 0.28 | |
| Sepsis | Yes | 3.33 | 3.2-3.47 | < 0.0001 |
| GI hemorrhage | Yes | 2.31 | 2.22-2.4 | < 0.0001 |
| Acute renal failure | Yes | 7.19 | 6.96-7.42 | < 0.0001 |
- Citation: Wakil A, Mohamed M, Tafesh Z, Niazi M, Olivo R, Xia W, Greenberg P, Pyrsopoulos N. Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study. World J Gastroenterol 2022; 28(34): 5036-5046
- URL: https://www.wjgnet.com/1007-9327/full/v28/i34/5036.htm
- DOI: https://dx.doi.org/10.3748/wjg.v28.i34.5036