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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Sex and racial disparities in non-alcoholic fatty liver disease-related cardiovascular events: National inpatient sample analysis (2019)
Rupak Desai, Ali Tariq Alvi, Advait Vasavada, Yashwitha Sai Pulakurthi, Bhavin Patel, Adil Sarvar Mohammed, Shreyans Doshi, Ikechukwu Ogbu
Rupak Desai, Independent Researcher, Atlanta, GA 30079, United States
Ali Tariq Alvi, Department of Internal Medicine, HCA Florida Westside Hospital, Plantation, FL 33324, United States
Advait Vasavada, Department of Internal Medicine, M.P. Shah Medical Coll, Jamnagar 361008, India
Yashwitha Sai Pulakurthi, Department of Internal Medicine, Saint Michael Medical Center, Newark, NJ 07102, United States
Bhavin Patel, Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, United States
Adil Sarvar Mohammed, Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
Shreyans Doshi, Department of Internal Medicine, UCF College of Medicine HCA GME Consortium, Gainesville, FL 32605, United States
Ikechukwu Ogbu, Department of Internal Medicine, Mountainview Hospital, Las Vegas, NV 89108, United States
Co-first authors: Rupak Desai and Ali Tariq Alvi.
Author contributions: Desai R designed the methodology and performed analysis; Desai R, Alvi AT, Vasavada A, Pulkurthi YS, Patel BA, Mohammed AS, Doshi S and Ogbu I were involved with data curation, visualization, and interpretation; Alvi AT, Pulkurthi YS, Patel BA, Vasavada A, and Mohammed AS were involved with writing of manuscript; Desai R, Alvi AT, Doshi S and Ogbu I performed reviewing and final editing; all authors have read and agreed to the published version of the manuscript; Desai R and Alvi AT are designated co-first authors, with Desai R contributing substantially to conceptualization, methodology, and editorial work, and Alvi AT to data curation, visualization, interpretation, and writing.
Institutional review board statement: Since the data included in this review were deidentified and already available in the publicly accessible databases, the IRB review was not mandatory. This review was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
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: Ikechukwu Ogbu, MD, Doctor, Department of Internal Medicine, Mountainview Hospital, 2880 N Tenaya Way, Las Vegas, NV 89108, United States. iogbu832267@gmail.com
Received: December 10, 2023
Peer-review started: December 10, 2023
First decision: December 29, 2023
Revised: January 15, 2024
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: March 26, 2024
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) increases cardiovascular disease (CVD) risk irrespective of other risk factors. However, large-scale cardiovascular sex and race differences are poorly understood.
AIM
To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events (MACCE) in subgroups using a nationally representative United States inpatient sample.
METHODS
We examined National Inpatient Sample (2019) to identify adult hospitalizations with NAFLD by age, sex, and race using ICD-10-CM codes. Clinical and demographic characteristics, comorbidities, and MACCE-related mortality, acute myocardial infarction (AMI), cardiac arrest, and stroke were compared in NAFLD cohorts by sex and race. Multivariable regression analyses were adjusted for sociodemographic characteristics, hospitalization features, and comorbidities.
RESULTS
We examined 409130 hospitalizations [median 55 (IQR 43-66) years] with NFALD. NAFLD was more common in females (1.2%), Hispanics (2%), and Native Americans (1.9%) than whites. Females often reported non-elective admissions, Medicare enrolment, the median age of 55 (IQR 42-67), and poor income. Females had higher obesity and uncomplicated diabetes but lower hypertension, hyperlipidemia, and complicated diabetes than males. Hispanics had a median age of 48 (IQR 37-60), were Medicaid enrollees, and had non-elective admissions. Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia. MACCE, all-cause mortality, AMI, cardiac arrest, and stroke were all greater in elderly individuals (P < 0.001). MACCE, AMI, and cardiac arrest were more common in men (P < 0.001). Native Americans (aOR 1.64) and Asian Pacific Islanders (aOR 1.18) had higher all-cause death risks than whites.
CONCLUSION
Increasing age and male sex link NAFLD with adverse MACCE outcomes; Native Americans and Asian Pacific Islanders face higher mortality, highlighting a need for tailored interventions and care.
Core Tip: Non-alcoholic fatty liver disease is associated with adverse major cardiovascular and cerebrovascular events, especially with increasing age and male sex. Native Americans and Asian Pacific Islanders had higher all-cause mortality.
