Peptic ulcer disease in non-alcoholic fatty liver disease hospitalizations: A new challenge on the horizon in the United States

Table 1 Hospitalization trends for non-alcoholic fatty liver disease hospitalizations with peptic ulcer disease in the United States from 2009-2019

Variable	Years
	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
Total hospitalizations	3745	4563	5230	5655	5759	6885	5745	2880	3070	3430
Mean age (yr)	56.01 ± 0.8	57.07 ± 0.75	56.68 ± 0.81	57.1 ± 0.14	57.1 ± 0.41	57.4 ± 0.59	57.5 ± 0.97	62.4 ± 0.41	62.8 ± 0.8	63.7 ± 0.74
Age groups, yr (%)
18-34	9	8	8	8	7	8	8	3	4	2
35-49	25	24	25	25	23	22	21	12	11	15
50-64	39	42	41	39	42	42	39	44	40	36
65-79	26	25	26	27	28	28	32	42	44	47
≥ 80	< 1	1	1	1	< 1	< 1	< 1	1	1	1
Gender (%)
Male	45	42	43	43	44	44	45	36	40	40
Female	55	48	57	58	56	56	55	64	60	50
Race (%)										0.01
White	72	73	70	71	72	71	70	74	76	76
Black	10	8	9	10	9	11	10	6	5	5
Hispanic	11	13	14	13	12	11	13	14	15	15
Asian	3	3	3	3	2	3	3	2	2	2
Native American	1	< 1	1	1	1	1	1	2	1	1
Other	3	3	3	3	3	4	3	3	2	4
CCI (%)
CCI = 0	0	0	0	0	0	0	0	0	0	0
CCI = 1	34	32	34	32	32	31	31	6	6	6
CCI = 2	27	24	23	22	22	22	25	13	8	10
CCI ≥ 3	39	44	43	47	46	47	44	86	86	86
Hospital region (%)
Northeast	13	12	14	16	15	14	14	13	13	16
Midwest	24	24	22	22	22	21	21	28	29	29
South	39	41	43	21	42	43	44	38	37	35
West	24	23	21	21	21	21	21	20	21	19
Hospital bed-size (%)
Small	8	11	11	13	11	16	16	15	16	16
Medium	25	25	22	29	26	32	29	24	25	28
Large	67	64	67	59	63	52	55	61	59	56
Hospital location and teaching status (%)
Rural	8	10	11	10	10	7	7	6	5	5
Urban non-teaching	47	50	45	41	37	26	27	21	20	14
Urban teaching	46	40	44	49	53	67	66	73	75	81
Primary payer
Medicare	41	42	41	44	43	44	44	53	60	60
Medicaid	13	15	14	15	15	16	16	14	11	11
Private	36	35	35	33	34	33	33	30	25	26
Other	10	8	10	8	8	7	7	2	3	3
Median household income (%)
1st (0-25th)	26	27	30	28	31	28	31	31	27	29
2nd (26th-50th)	25	24	25	24	26	29	24	27	32	32
3rd (51st-75th)	30	24	24	26	24	23	26	24	25	21
4th (76th-100th)	19	24	21	22	19	20	19	17	15	18
Upper endoscopy (%)	60	59	62	58	59	59	62	20	22	18

CCI: Charlson Comorbidity Index.

Table 2 Trends of outcomes for non-alcoholic fatty liver disease hospitalizations with peptic ulcer disease in the United States from 2009-2019

Outcome	Years											Pvalue
	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019
Inpatient mortality (%)	2	1	2	2	2	2	1	4	4	5	5	< 0.001
Gender-specific inpatient mortality (%)												0.2
Male	25	21	28	57	53	38	40	37	52	32	31
Female	75	79	72	43	47	62	60	63	48	48	48
Race-specific inpatient mortality (%)												0.4
White	81	53	89	48	79	73	73	71	81	61	64
Black	7	0	0	14	0	4	0	4	4	6	11
Hispanic	12	47	11	19	16	19	7	17	8	19	14
Asian	0	0	0	10	5	0	0	4	0	3	6
Native American	0	0	0	5	0	0	7	0	4	3	6
Others	0	0	0	5	0	4	13	4	4	6	0
Age-group specific inpatient mortality (%)												0.1
18-34	7	0	0	0	0	3	0	0	0	0	0
35-49	13	26	16	13	0	17	14	9	22	14	6
50-64	51	36	33	31	29	34	36	41	52	31	48
65-79	28	24	36	56	71	41	50	50	26	48	45
≥ 80	0	13	14	0	0	3	0	0	0	3	0
Length of stay (d)	17.1 ± 0.59	11.8 ± 0.76	16.3 ± 0.58	9.2 ± 0.85	9.0 ± 0.01	8.2 ± 0.68	10.1 ± 0.33	9.6 ± 0.49	17.3 ± 0.33	9.2 ± 0.90	11.2 ± 0.22	0.06
Total hospital charge ($)	182296 ± 760	104265 ± 620	215085 ± 130	172837 ± 170	157079 ± 890	105031 ± 760	136876 ± 800	134573 ± 730	373045 ± 450	143284 ± 940	174044 ± 550	0.8
Complications (%)
Bleeding	0	21	0	0	5	10	7	17	7	10	11	0.4
Perforation	33	12	35	29	16	3	13	17	11	3	8	0.02

Table 3 Comparative analysis of hospitalization characteristics for non-alcoholic fatty liver disease hospitalizations with peptic ulcer disease and non-NALFD hospitalizations with peptic ulcer disease in the United States from 2009-2019

	NAFLD hospitalizations with PUD	Non-NAFLD hospitalizations with PUD	P value
Total hospitalizations	50769 (1%)	4624628 (99%)
Mean age (yr)	58.6 ± 0.27	65.3 ± 0. 80	< 0.001
Age group, yr (%)			< 0.001
18-34	6	6
35-49	21	15
50-64	40	33
65-79	32	40
≥ 80	1	6
Gender (%)			< 0.001
Male	42	49
Female	48	51
Race (%)			< 0.001
White	72	70
Black	9	14
Hispanic	13	9
Asian	3	3
Native American	1	1
Other	3	3
CCI (%)			< 0.001
CCI = 0	0	0
CCI = 1	25	30
CCI = 2	20	22
CCI ≥ 3	55	49
Upper endoscopy (%)	49	41	< 0.001
H. pylori (%)	3	3	0.5
Hospital region (%)			< 0.001
Northeast	14	18
Midwest	24	23
South	41	39
West	21	20
Hospital bed size (%)			< 0.001
Small	14	16
Medium	27	28
Large	59	56
Hospital location and teaching status (%)			< 0.001
Rural	8	10
Urban nonteaching	32	34
Urban teaching	60	56
Expected primary payer (%)			< 0.001
Medicare	47	61
Medicaid	14	12
Private	32	21
Other	7	5
Median household income (quartile) (%)			< 0.001
1st (0-25th)	29	31
2nd (26th-50th)	27	26
3rd (51st-75th)	25	24
4th (76th-100th)	20	19

CCI: Charlson Comorbidity Index; NAFLD: Non-alcoholic fatty liver disease; PUD: Peptic ulcer disease.

Table 4 Comparative analysis of outcomes for non-alcoholic fatty liver disease hospitalizations with peptic ulcer disease and non-NAFLD hospitalizations with peptic ulcer disease in the United States from 2009-2019

Outcomes	NAFLD hospitalizations with PUD	Non-NAFLD hospitalizations with PUD	P value
Inpatient mortality (%)	2	3	0.0004
Gender-specific inpatient mortality (%)			< 0.001
Male	38	54
Female	62	46
Race-specific inpatient mortality (%)			< 0.001
White	70	72
Black	6	12
Hispanic	16	9
Asian	3	4
Native American	3	1
Others	3	3
Age-group specific inpatient mortality (%)			< 0.001
18-34	1	2
35-49	13	7
50-64	39	30
65-79	44	49
≥ 80	2	12
Length of stay (d)	11.6	12.1	< 0.001
Total healthcare cost ($)	178598	184727	< 0.001
Complications (%)
Bleeding	8	6	0.2
Perforations	14	18	0.1

NAFLD: Non-alcoholic fatty liver disease; PUD: Peptic ulcer disease.

Table 5 Predictors of all-cause inpatient mortality for non-alcoholic fatty liver disease hospitalizations with peptic ulcer disease in the United States from 2009-2019

Variable	Adjusted hazard ratio	95% confidence interval	P value
Coagulopathy	2.24	2.14-2.34	< 0.001
Obesity	0.79	0.74-0.84	< 0.001
Protein calorie malnutrition	1.16	1.11-1.22	< 0.001
Fluid and electrolyte disorder	1.92	1.82-2.01	< 0.001
Alcohol abuse	1.51	1.42-1.61	< 0.001
Perforation	2.71	1.37-5.35	0.004