Cotter Thomas G, Anouti Ahmad, Zhang Bill, Rady Elias D, Patel Mausam, Patel Suraj, Ellis Daniel J, Lieber Sarah R, Rich Nicole E, O'Leary Jacqueline G, Mitchell Mack C, Singal Amit G
Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.
Department of Internal Medicine, UT Southwestern Medical Centre, Dallas, Texas, USA.
Aliment Pharmacol Ther. 2025 Mar;61(6):988-999. doi: 10.1111/apt.18477. Epub 2025 Jan 16.
Alcohol-associated liver disease (ALD) disproportionately impacts men, racial and ethnic minorities, and individuals of low socioeconomic status; however, it's unclear how recent increases in ALD burden have impacted these disparities. We aimed to describe trends in racial, ethnic and socioeconomic disparities in alcohol-associated hospital encounters.
We conducted a retrospective cohort study of adult hospital encounters with alcohol-associated diagnoses from three health systems between January 2016 and December 2021. The cohort was divided into three eras: a 'Historical Era,' (Oct 2016-June 2018, used only for trends); 'Era 1' (July 2018-March 2020); and 'Era 2' (April 2020-December 2021). Kaplan Meier and Cox regression analyses were performed to identify factors associated with overall survival.
We identified 19,295 individuals with alcohol-associated encounters (44.7% White, 29.8% Hispanic, and 21.8% non-Hispanic Black (NHB) individuals), with a greater increase observed between eras 1 and 2 than the historical era and Era 1 (8.7% vs. 5.0%, p < 0.01). By age and sex, the greatest increases in encounters were observed in the youngest and oldest females but only the oldest males. By race and ethnicity, Hispanic individuals had greater increases in encounters compared to Black and White individuals (14.8% vs. 7.5% and 6.3%, p < 0.01). Older age (aSHR: 1.03, 95% CI: 1.03-1.0), higher MELD (aSHR: 1.08, 95% CI: 1.0-1.09), hepatic encephalopathy (aSHR: 1.42, 95% CI: 1.06-1.90), and hepatocellular carcinoma (HCC) (aSHR: 3.20, 95% CI: 2.29-4.49) were associated with increased mortality.
The highest increases of alcohol-associated encounters were observed amongst young Hispanic and NHB women, highlighting variation in trends by age, sex, race and ethnicity. These disparities merit further investigation to elucidate underlying mechanisms and develop tailored interventions to improve ALD burden and outcomes.
酒精性肝病（ALD）对男性、少数族裔以及社会经济地位较低的个体影响尤为严重；然而，目前尚不清楚ALD负担最近的增加对这些差异产生了怎样的影响。我们旨在描述酒精相关住院病例中种族、民族和社会经济差异的趋势。
我们对2016年1月至2021年12月期间来自三个医疗系统的成年住院病例进行了回顾性队列研究，这些病例均有酒精相关诊断。该队列分为三个时期：“历史时期”（2016年10月 - 2018年6月，仅用于趋势分析）；“时期1”（2018年7月 - 2020年3月）；以及“时期2”（2020年4月 - 2021年12月）。采用Kaplan Meier和Cox回归分析来确定与总体生存相关的因素。
我们确定了19295例有酒精相关住院病例的个体（44.7%为白人，29.8%为西班牙裔，21.8%为非西班牙裔黑人（NHB）个体），时期2与时期1之间的增长幅度大于历史时期与时期1之间的增长幅度（8.7%对5.0%，p < 0.01）。按年龄和性别划分，住院病例增长幅度最大的是最年轻和最年长的女性，但只有最年长的男性。按种族和民族划分，与黑人和白人个体相比，西班牙裔个体的住院病例增长幅度更大（14.8%对7.5%和6.3%，p < 0.01）。年龄较大（调整后风险比：1.03，95%置信区间：1.03 - 1.0）、较高的终末期肝病模型（MELD）评分（调整后风险比：1.08，95%置信区间：1.0 - 1.09）、肝性脑病（调整后风险比：1.42，95%置信区间：1.06 - 1.90）和肝细胞癌（HCC）（调整后风险比：3.20，95%置信区间：2.29 - 4.49）与死亡率增加相关。
在年轻的西班牙裔和NHB女性中观察到酒精相关住院病例增长幅度最大，突出了年龄、性别、种族和民族在趋势上的差异。这些差异值得进一步研究，以阐明潜在机制并制定针对性的干预措施，以改善ALD负担和治疗结果。
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