Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2022; 14(9): 1804-1816
Published online Sep 27, 2022. doi: 10.4254/wjh.v14.i9.1804
Hereditary hemochromatosis: Temporal trends, sociodemographic characteristics, and independent risk factor of hepatocellular cancer – nationwide population-based study
Maryam Bilal Haider, Ali Al Sbihi, Ahmed Jamal Chaudhary, Syed M Haider, Ahmed Iqbal Edhi
Maryam Bilal Haider, Ali Al Sbihi, Ahmed Jamal Chaudhary, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Sinai Grace Hospital, Detroit, MI 48235, United States
Syed M Haider, System Science, Binghamton University, Binghamton, NY 13902, United States
Ahmed Iqbal Edhi, Department of Gastroenterology, William Beaumont Hospital, Royal Oak, MI 48073, United States
Author contributions: Haider M was responsible for study design and interpretations of results; Haider M and Al Sbihi A were responsible for literature review and manuscript preparation; Haider S was responsible for data collection; Chaudhary A and Edhi A were responsible for the overall supervision and final approval.
Institutional review board statement: Data from this study used de-identified data from the National Inpatient Sample Database (NIS) 2011-2019. A publicly available all-payer inpatient care database in the United States. Institutional Review Board Approval Form or Document is not required.
Informed consent statement: Data from this study used de-identified data from the National Inpatient Sample Database. A publicly available all-payer inpatient care database in the United States. Informed patient consent is not required.
Conflict-of-interest statement: All authors declare no conflict of interests for this article.
Data sharing statement: Data that support the findings of this study are publicly available at https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maryam Bilal Haider, MD, Doctor, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Sinai Grace Hospital, 6071 Outer Dr W, Detroit, MI 48235, United States. maryambilalhaider@yahoo.com
Received: May 5, 2022
Peer-review started: May 5, 2022
First decision: June 8, 2022
Revised: June 20, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: September 27, 2022
Processing time: 140 Days and 11.9 Hours
ARTICLE HIGHLIGHTS
Research background

Hereditary hemochromatosis (HH) is an inherited genetic iron metabolism disorder characterized by high iron deposition in body organs due to elevated alimentary iron absorption. Because the liver is one of the most affected organs, HH is a risk factor for hepatocellular carcinoma (HCC) due to genetics and iron carcinogenic effects. HH as an independent risk factor of HCC and trends of admitted HH patients’ characteristics and admission demographics are understudied research topics.

Research motivation

Current large cohort studies on temporal trends, length of stay (LOS), costs, and sociodemographic characteristics of admitted HH patients, in addition to HH being an independent risk factor of HCC, are limited.

Research objectives

We aim to evaluate patient characteristics, admission trends, LOS, and costs for admitted HH in the United States over the last decade. We also consider HH an independent risk factor for developing HCC without cirrhosis.

Research methods

We used the national inpatient sample database for our study. We identified a sample of 18031 hospital admissions of primary or secondary HH. We selected HH and HCC cohorts. HH was first defined in 2011 as ICD-9 as a separate diagnosis. The HH cohort was extracted from January 2011 to December 2019 using 275.01 (ICD-9) and E83.110 (ICD-10) diagnosis codes. We excluded patients with cirrhosis of different etiologies. The HCC cohort was selected from January 2011 to December 2019 using ICD-9 and ICD-10 codes for HCC. A non-HCC cohort was selected with the 1:1 fixed ratio nearest neighbor propensity score using patients' age, gender, and race. Multivariate analysis was performed for the risk factors of HCC in the HCC and non-HCC matched cohorts. We further analyzed HH without cirrhosis as an independent risk factor of HCC after adjusting all known risk factors of HCC in the multivariate model.

Research results

Most admitted HH patients were white males with a mean age of 62 years. Increments in HH inpatient population trend with a Ptrend < 0.001 and total hospital cost of care trend from $42957 in 2011 to $66152 in 2019 with a Ptrend < 0.001 were found despite no change in LOS over the last decade. The incidence of liver cancer in HH patients is 1.2% (95%CI: 0.78-1.53). HH without cirrhosis had 28.8 higher odds of developing HCC.

Research conclusions

There were increments in the trend of HH admissions and costs over the last decade with no changes in LOS. HH without cirrhosis is an independent risk factor for HCC.

Research perspectives

These trends could be related to advances in diagnostic approaches, which increase hospital admissions and costs. Still, outpatient-based management could be a related factor to the unchanged LOS.