Jahagirdar Vinay, Gautam Misha, Rasheed Waqas, Blaney Hanna, Ali Hassam, Ghoz Hassan
Department of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA 23219, United States.
Department of Internal Medicine, University of Missouri-Kansas City, Kansas, MI 64110, United States.
World J Virol. 2025 Jun 25;14(2):97421. doi: 10.5501/wjv.v14.i2.97421.
Hepatitis A virus (HAV) infection remains the most common cause of acute viral hepatitis globally. In the United States, recent outbreaks have been attributed primarily to person-to-person transmission, with vulnerable populations such as people who use illicit drugs, those experiencing homelessness, and men who have sex with men disproportionately affected.
To assess the trends in HAV hospitalizations over the past decade and evaluate the impact of substance use on these hospitalizations.
We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2020. Adults (≥ 18 years) hospitalized with a primary diagnosis of HAV infection were included. We identified active substance use as a secondary diagnosis. Statistical analysis involved descriptive statistics, trend analysis, and propensity score matching to compare HAV hospitalizations with and without substance use. Outcomes included hospitalization trends, complications, length of stay (LOS), and mortality.
From 2011 to 2020, there were 56972 hospitalizations for HAV infections. Hospitalizations increased from 3917 in 2011 to 8290 in 2020, peaking at 9800 in 2018. Caucasian males (55%) were the most affected, with a mean age of 49 years. The prevalence of active substance use among HAV hospitalizations was 27%, with these patients being younger (mean age: 39 years) and predominantly male (63.1%). HAV hospitalizations associated with substance use increased significantly, rising from 235 cases in 2011 to 3200 in 2020 ( < 0.001). Compared to HAV hospitalizations without substance use, those with substance use had higher rates of co-infections (hepatitis C virus 45% 11%, hepatitis B virus 11% 6%) and complications, including sepsis (1.9% 1%) and infective endocarditis (1.4% 0.15%, < 0.001). Hospitalizations with substance use also had longer LOS (4.34 days 3.97 days, < 0.05), but mortality rates were comparable. Predictors of mortality in HAV-substance use hospitalizations included acute liver failure, sepsis, and acute respiratory failure.
HAV hospitalizations in the United States have significantly increased over the past decade, with the rise driven by cases involving substance use. These patients face a higher burden of complications and healthcare utilization. Tailored public health strategies, including targeted vaccination and outreach programs for at-risk populations, are essential to reduce the morbidity, mortality, and economic burden associated with HAV.
甲型肝炎病毒（HAV）感染仍是全球急性病毒性肝炎最常见的病因。在美国，近期的疫情主要归因于人际传播，弱势群体如使用非法药物者、无家可归者以及男男性行为者受到的影响尤为严重。
评估过去十年中HAV住院病例的趋势，并评估药物使用对这些住院病例的影响。
我们使用2011年至2020年的全国住院患者样本数据库进行了一项回顾性研究。纳入以HAV感染为主要诊断住院的成年人（≥18岁）。我们将药物使用活跃作为次要诊断。统计分析包括描述性统计、趋势分析和倾向得分匹配，以比较有和没有药物使用的HAV住院病例。结果包括住院趋势、并发症、住院时间（LOS）和死亡率。
2011年至2020年期间，有56972例因HAV感染住院。住院病例从2011年的3917例增加到2020年的8290例，2018年达到峰值9800例。白人男性（55%）受影响最大，平均年龄为49岁。HAV住院病例中药物使用活跃的患病率为27%，这些患者更年轻（平均年龄：39岁），且主要为男性（63.1%）。与药物使用相关的HAV住院病例显著增加，从2011年的235例增至2020年的3200例（<0.001）。与无药物使用的HAV住院病例相比，有药物使用的病例合并感染率更高（丙型肝炎病毒45%对11%，乙型肝炎病毒11%对6%），并发症更多，包括败血症（1.9%对1%）和感染性心内膜炎（1.4%对0.15%，<0.001）。有药物使用的住院病例住院时间也更长（4.34天对3.97天，<0.05），但死亡率相当。HAV药物使用住院病例的死亡预测因素包括急性肝衰竭、败血症和急性呼吸衰竭。
在过去十年中，美国HAV住院病例显著增加，增长由涉及药物使用的病例推动。这些患者面临更高的并发症负担和医疗资源利用。制定针对性的公共卫生策略，包括针对高危人群的疫苗接种和外展项目，对于降低与HAV相关的发病率、死亡率和经济负担至关重要。
