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种族/民族与原发性胆汁性胆管炎成人住院死亡率的保险特定差异:2007-2014 年全国住院患者样本分析。

Race/Ethnicity and Insurance-Specific Disparities in In-Hospital Mortality Among Adults with Primary Biliary Cholangitis: Analysis of 2007-2014 National Inpatient Sample.

机构信息

Department of Medicine, California Pacific Medical Center, 2351 Clay Street, San Francisco, CA, 94115, USA.

Department of Medicine, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA.

出版信息

Dig Dis Sci. 2020 Feb;65(2):406-415. doi: 10.1007/s10620-019-05809-x. Epub 2019 Sep 5.

Abstract

BACKGROUND

Primary biliary cholangitis (PBC) is a progressive autoimmune liver disease that can result in cirrhosis and end-stage liver disease.

AIMS

We aim to evaluate hospitalization burden and in-hospital mortality among PBC patients in the USA.

METHODS

Using data from the Nationwide Inpatient Sample from 2007 to 2014, hospitalizations among US adults with PBC were stratified by sex, age, and race/ethnicity. Overall in-hospital mortality was stratified by these variables and adjusted multivariate regression models evaluated for predictors of in-hospital mortality.

RESULTS

From 2007 to 2014, there were 18,279 hospitalizations among adults with PBC (15.0% male, mean age 63.8 years, 41.3% cirrhosis). Among non-Hispanic whites, the proportion of total PBC hospitalizations increased from 57.8% in 2007 to 71.2% in 2014, compared to 4.1-6.3% for African-Americans, 8.6-10.9% for Hispanics, and 1.7-2.8% for Asians (p < 0.001 for all). While overall in-hospital mortality was low (4.2%), increasing age was associated with higher odds of in-hospital mortality (OR: 1.02, 95% CI 1.01-1.03, p < 0.001). Compared to non-Hispanic white PBC patients, higher in-hospital mortality was observed in African-American PBC patients (OR: 1.40, 95% CI 1.16-2.03, p < 0.05). Compared to patients with private/commercial insurance, significantly higher odds of in-hospital mortality were observed in patients with Medicaid insurance (OR 1.42, 95% CI 1.00-1.99, p < 0.05).

CONCLUSION

In summary, among adults with PBC hospitalized in the USA from 2007 to 2014, the overall number of hospitalizations is increasing. Significant disparities in in-hospital mortality were observed; African-Americans with PBC and Medicaid patients with PBC have disproportionately higher odds of in-hospital mortality.

摘要

背景

原发性胆汁性胆管炎(PBC)是一种进行性自身免疫性肝病,可导致肝硬化和终末期肝病。

目的

我们旨在评估美国 PBC 患者的住院负担和住院死亡率。

方法

使用 2007 年至 2014 年全国住院患者样本的数据,按性别、年龄和种族/族裔对美国成年人的 PBC 住院情况进行分层。根据这些变量对总体住院死亡率进行分层,并通过调整多变量回归模型评估住院死亡率的预测因素。

结果

2007 年至 2014 年,共有 18279 例成年人患有 PBC(男性占 15.0%,平均年龄 63.8 岁,41.3%为肝硬化)。在非西班牙裔白人中,PBC 总住院率从 2007 年的 57.8%增加到 2014 年的 71.2%,而非洲裔美国人的比例为 4.1-6.3%,西班牙裔为 8.6-10.9%,亚洲人为 1.7-2.8%(所有 p<0.001)。尽管总体住院死亡率较低(4.2%),但年龄增长与更高的住院死亡率相关(OR:1.02,95%CI 1.01-1.03,p<0.001)。与非西班牙裔白人 PBC 患者相比,非裔美国 PBC 患者的住院死亡率更高(OR:1.40,95%CI 1.16-2.03,p<0.05)。与私人/商业保险相比,医疗补助保险患者的住院死亡率明显更高(OR 1.42,95%CI 1.00-1.99,p<0.05)。

结论

综上所述,2007 年至 2014 年期间,美国住院的 PBC 成年人中,住院人数总体呈上升趋势。观察到住院死亡率存在显著差异;非裔美国 PBC 患者和 PBC 医疗补助保险患者的住院死亡率过高。

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