Trends of Costs and Admission Rates Among Patients Admitted With Autoimmune Hepatitis: Analysis of US Hospitals Using the NIS Database

David U Lee; Kimberly Schuster; Aneesh Bahadur; Sophie Schellhammer; Reid Ponder; Emma Mitchell-Sparke; Gregory H Fan; Ki J Lee; Harrison Chou; Zurabi Lominadze

doi:10.1016/j.jceh.2023.08.015

Trends of Costs and Admission Rates Among Patients Admitted With Autoimmune Hepatitis: Analysis of US Hospitals Using the NIS Database

J Clin Exp Hepatol. 2024 Jan-Feb;14(1):101279. doi: 10.1016/j.jceh.2023.08.015. Epub 2023 Sep 1.

Affiliations

¹ Division of Gastroenterology and Hepatology, University of Maryland, 22 S. Greene St, Baltimore, MD, 21201, USA.
² Department of Medicine, Tufts University School of Medicine, Washington St, Boston, MA, 02111, USA.
³ Vanderbilt University School of Medicine, 21st Ave S, Nashville, TN, USA.

PMID: 38076380
PMCID: PMC10709195 (available on 2025-01-01)
DOI: 10.1016/j.jceh.2023.08.015

Abstract

Background and aim: Autoimmune hepatitis (AIH) is a prominent cause of chronic liver disease in the United States. This study aims to characterize the incidence, mortality, and cost implications of this condition using a national database.

Method: The 2016-2019 National Inpatient Sample was used to select patients with AIH. After adjusting for inflation, weighted charge data were used to calculate the admission costs using charge-to-cost ratios. Demographic, socioeconomic status, and comorbidity values were used to build strata to characterize admission incidence, mortality data and aggregate and per-capita cost values. Furthermore, additional sensitivity analysis was performed using a stratified set of patients with AIH as one of the top 10 diagnosis (AIH-specific subsample). Multinomial regression curves were graphed and assessed to derive goodness-of-fit for each trend. R² and P-values were calculated.

Results: From 2016 to 2019, the total admissions related to AIH were approximately 20,984, 21,905, 22,055, and 22,680 cases, respectively (R²: 0.93, P-value: 0.03). AIH-related hospitalization aggregate costs came to $338.18, $369.17, $355.98, and $387.25 million dollars (R²: 0.75, P-value: 0.17). Significant admission growth was seen in the Southern region (R²: 0.91, P-value: 0.05). Most notably, increasing trends in total admissions were found across older age, those of White and Hispanic descent, and those with comorbidities. On the other hand, the AIH-specific subsample illustrated decreasing trends in admissions across demographics (i.e., age, gender, and race) and comorbidities; however, those with hepatic complications saw a rise in the admission trends (cirrhosis - R²: 0.98, P-value: 0.009; multiple liver complications - R²: 0.95, P-value: 0.03).

Conclusion: Among AIH-specific admissions, there was a decreasing trend overall; however, there was an exceptional increase in the admissions among those with hepatic complications.

Keywords: AIH; inflation-adjusted admission costs; liver decompensation; regression trends; weighted analysis of national data.