Adejumo Adeyinka Charles, Samuel Gbeminiyi Olanrewaju, Adegbala Oluwole Muyiwa, Adejumo Kelechi Lauretta, Ojelabi Ogooluwa, Akanbi Olalekan, Ogundipe Olumuyiwa Akinbolaji, Pani Lydie
Department of Medicine, North Shore Medical Center, Salem, MA (Adeyinka Charles Adejumo, Lydie Pani).
Department of Medicine, Tufts University Medical School, Boston, MA (Adeyinka Charles Adejumo, Lydie Pani).
Ann Gastroenterol. 2019 Sep-Oct;32(5):504-513. doi: 10.20524/aog.2019.0402. Epub 2019 Jul 17.
As the frequency of nonalcoholic fatty liver disease (NAFLD) continues to rise in the United States (US) community, more patients are hospitalized with NAFLD. However, data on the prevalence and outcomes of hospitalizations with NAFLD are lacking. We investigated the prevalence, trends and outcomes of NAFLD hospitalizations in the US.
Hospitalizations with NAFLD were identified in the National Inpatient Sample (2007-2014) by their ICD-9-CM codes, and the prevalence and trends over an 8-year period were calculated among different demographic groups. After excluding other causes of liver disease among the NAFLD cohorts (n=210,660), the impact of sex, race and region on outcomes (mortality, discharge disposition, length of stay [LOS], and cost) were computed using generalized estimating equations (SAS 9.4).
Admissions with NAFLD tripled from 2007-2014 at an average rate of 79/100,000 hospitalizations/year (P<0.0001), with a larger rate of increase among males vs. females (83/100,000 vs. 75/100,000), Hispanics vs. Whites vs. Blacks (107/100,000 vs. 80/100,000 vs. 48/100,000), and government-insured or uninsured patients vs. privately-insured (94/100,000 vs. 74/100,000). Males had higher mortality, LOS, and cost than females. Blacks had longer LOS and poorer discharge destination than Whites; while Hispanics and Asians incurred higher cost than Whites. Uninsured patients had higher mortality, longer LOS, and poorer discharge disposition than the privately-insured.
Hospitalizations with NAFLD are rapidly increasing in the US, with a disproportionately higher burden among certain demographic groups. Measures are required to arrest this ominous trend and to eliminate the disparities in outcome among patients hospitalized with NAFLD.
随着非酒精性脂肪性肝病（NAFLD）在美国社区的发病率持续上升，越来越多的NAFLD患者住院治疗。然而，关于NAFLD住院治疗的患病率和结局的数据却很缺乏。我们调查了美国NAFLD住院治疗的患病率、趋势和结局。
通过ICD-9-CM编码在国家住院患者样本（2007-2014年）中识别出NAFLD住院病例，并计算了8年期间不同人口统计学组的患病率和趋势。在排除NAFLD队列（n=210,660）中其他肝病病因后，使用广义估计方程（SAS 9.4）计算性别、种族和地区对结局（死亡率、出院处置、住院时间[LOS]和费用）的影响。
2007年至2014年期间，NAFLD住院病例增加了两倍，平均每年79/100,000例住院病例（P<0.0001），男性的增长率高于女性（83/100,000对75/100,000），西班牙裔高于白人高于黑人（107/100,000对80/100,000对48/100,000），政府保险或无保险患者高于私人保险患者（94/100,000对74/100,000）。男性的死亡率、住院时间和费用高于女性。黑人的住院时间比白人长，出院目的地比白人差；而西班牙裔和亚洲人的费用比白人高。无保险患者的死亡率更高、住院时间更长、出院处置比私人保险患者差。
在美国，NAFLD住院病例正在迅速增加，某些人口统计学组的负担尤其沉重。需要采取措施阻止这一不祥趋势，并消除NAFLD住院患者之间结局的差异。
