Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System.
Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA.
J Clin Gastroenterol. 2021 Aug 1;55(7):624-630. doi: 10.1097/MCG.0000000000001452.
Over 2.1 million individuals in the United Stats have cirrhosis, including 513,000 with decompensated cirrhosis. Hospitals with high safety-net burden disproportionately serve ethnic minorities and have reported worse outcomes in surgical literature. No studies to date have evaluated whether hospital safety-net burden negatively affects hospitalization outcomes in cirrhosis. We aim to evaluate the impact of hospitals' safety-net burden and patients' ethnicity on in-hospital mortality among cirrhosis patients.
Using National Inpatient Sample data from 2012 to 2016, the largest United States all-payer inpatient health care claims database of hospital discharges, cirrhosis-related hospitalizations were stratified into tertiles of safety-net burden: high (HBH), medium (MBH), and low (LBH) burden hospitals. Safety-net burden was calculated as percentage of hospitalizations per hospital with Medicaid or uninsured payer status. Multivariable logistic regression evaluated factors associated with in-hospital mortality.
Among 322,944 cirrhosis-related hospitalizations (63.7% white, 9.9% black, 15.6% Hispanic), higher odds of hospitalization in HBHs versus MBH/LBHs was observed in blacks (OR, 1.26; 95%CI, 1.17-1.35; P<0.001) and Hispanics (OR, 1.63; 95% CI, 1.50-1.78; P<0.001) versus whites. Cirrhosis-related hospitalizations in MBHs or HBHs were associated with greater odds of in-hospital mortality versus LBHs (HBH vs. LBH: OR, 1.05; 95% CI, 1.00-1.10; P=0.044). Greater odds of in-hospital mortality was observed in blacks (OR, 1.27; 95% CI, 1.21-1.34; P<0.001) versus whites.
Cirrhosis patients hospitalized in HBH experienced 5% higher mortality than those in LBH, resulting in significantly greater deaths in cirrhosis patients. Even after adjusting for safety-net burden, blacks with cirrhosis had 27% higher in-hospital mortality compared with whites.
美国有超过 210 万人患有肝硬化，其中包括 51.3 万名失代偿期肝硬化患者。安全网负担较重的医院不成比例地为少数民族服务，并且在外科文献中报告的结果更差。迄今为止，尚无研究评估医院安全网负担是否会对肝硬化患者的住院治疗结果产生负面影响。我们旨在评估医院安全网负担和患者种族对肝硬化患者住院死亡率的影响。
使用 2012 年至 2016 年的国家住院患者样本数据，这是美国最大的涵盖所有支付方的住院患者医疗保健索赔数据库的医院出院记录，将与肝硬化相关的住院患者分为安全网负担的三个三分位数：高（HBH）、中（MBH）和低（LBH）负担医院。安全网负担是通过医院中按医院计算的医疗保险或无保险支付者身份的住院人数百分比来计算的。多变量逻辑回归评估与院内死亡率相关的因素。
在 322944 例与肝硬化相关的住院患者中（63.7%为白人，9.9%为黑人，15.6%为西班牙裔），与 MBH/LBH 相比，HBH 中黑人（比值比[OR]，1.26；95%置信区间[CI]，1.17-1.35；P<0.001）和西班牙裔（OR，1.63；95%CI，1.50-1.78；P<0.001）住院的可能性更高。MBH 或 HBH 中的肝硬化相关住院与 LBH 相比，院内死亡率的可能性更高（HBH 与 LBH：OR，1.05；95%CI，1.00-1.10；P=0.044）。与白人相比，黑人（OR，1.27；95%CI，1.21-1.34；P<0.001）的院内死亡率更高。
HBH 中肝硬化患者的死亡率比 LBH 中肝硬化患者高 5%，导致肝硬化患者的死亡人数明显增加。即使在调整了安全网负担后，与白人相比，患有肝硬化的黑人的院内死亡率仍高出 27%。
