Division of Gastroenterology, Department of Medicine.
Division of Endocrinology, Department of Medicine.
J Clin Gastroenterol. 2023;57(5):508-514. doi: 10.1097/MCG.0000000000001698. Epub 2022 Apr 1.
Nonalcoholic steatohepatitis (NASH) is an increasingly common etiology for liver-related hospitalizations in the United States. The aim of this study was to examine the differences of disease characteristics and outcomes between hospitalized Black and White patients with NASH.
We used the National Inpatient Sample (NIS) to identify all adult hospitalizations with NASH (ICD-10 code: K75.81) from 2016 to 2018. We compared demographic and clinical characteristics between Black and White patients. Multivariable models were computed to compare all-cause mortality, length of stay (LOS), and total hospital costs between the groups.
There were 43,409 hospitalizations with NASH (41,143 White, 2266 Black). Black patients were less likely to have cirrhosis (33.6%) compared with Whites (56.4%), P <0.0001. Black patients were less likely to have esophageal variceal bleeding (1.2% vs. 3.5%), ascites (17.1% vs. 28.8%), and acute liver failure (16.2% vs. 28.9%) compared with Whites (all P <0.0001). These findings were consistent among patients with cirrhosis. Mortality was higher among Blacks compared with Whites (3.9% vs. 3.7%, adjusted odds ratio=1.34; 95% confidence interval: 1.05-1.71, P =0.018). Compared with Whites, Blacks had a longer LOS (6.3 vs. 5.6, P <0.001), and higher hospital costs ($18,602 vs. $17,467; P =0.03).
In this large population of inpatients with NASH, Black patients were less likely to have cirrhosis and liver disease-related complications, but had overall worse hospital mortality, longer LOS, and higher hospital costs. Further research is warranted to elaborate on factors that generate the health inequities in NASH outcomes between Black and White patients.
非酒精性脂肪性肝炎（NASH）是美国与肝脏相关的住院治疗日益常见的病因。本研究的目的是研究黑人和白人 NASH 住院患者的疾病特征和结局差异。
我们使用国家住院患者样本（NIS）从 2016 年至 2018 年确定所有患有 NASH 的成年住院患者（ICD-10 代码：K75.81）。我们比较了黑人和白人患者的人口统计学和临床特征。计算多变量模型比较两组之间的全因死亡率、住院时间（LOS）和总住院费用。
共有 43409 例 NASH 住院患者（41143 例白人，2266 例黑人）。与白人相比，黑人患者肝硬化（33.6%对 56.4%）的可能性较低，P<0.0001。黑人患者食管静脉曲张出血（1.2%对 3.5%）、腹水（17.1%对 28.8%）和急性肝功能衰竭（16.2%对 28.9%）的可能性低于白人（所有 P<0.0001）。在肝硬化患者中也存在这些发现。与白人相比，黑人的死亡率更高（3.9%对 3.7%，调整后的优势比=1.34；95%置信区间：1.05-1.71，P=0.018）。与白人相比，黑人的 LOS 更长（6.3 对 5.6，P<0.001），且住院费用更高（18602 美元对 17467 美元；P=0.03）。
在这项大型 NASH 住院患者人群中，黑人患者肝硬化和肝病相关并发症的可能性较低，但总体死亡率更高、住院时间更长、住院费用更高。需要进一步研究以详细说明导致黑人和白人 NASH 结局健康不平等的因素。
