Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians

Elizabeth E Powell; Richard Skoien; Tony Rahman; Paul J Clark; James O'Beirne; Gunter Hartel; Katherine A Stuart; Steven M McPhail; Rohit Gupta; Peter Boyd; Patricia C Valery

doi:10.1016/j.eclinm.2019.05.007

Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians

EClinicalMedicine. 2019 Jun 13:11:44-53. doi: 10.1016/j.eclinm.2019.05.007. eCollection 2019 May-Jun.

Authors

Elizabeth E Powell^{1

2}, Richard Skoien³, Tony Rahman⁴, Paul J Clark^{1

5}, James O'Beirne⁶, Gunter Hartel⁷, Katherine A Stuart¹, Steven M McPhail⁸, Rohit Gupta⁹, Peter Boyd¹⁰, Patricia C Valery⁷

Affiliations

¹ Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
² Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
³ Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
⁴ Gastroenterology & Hepatology Department, The Prince Charles Hospital, Chermside, QLD, Australia.
⁵ Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia.
⁶ Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia.
⁷ QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
⁸ Centre for Functioning and Health Research, Queensland Health and the School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
⁹ Logan Hospital, Meadowbrook, QLD, Australia.
¹⁰ Cairns Base Hospital, Cairns, QLD, Australia.

Abstract

Background: Limited information is available about hospitalization rates for cirrhosis in Australia.

Methods: Using information on all hospital episodes of care for patients admitted to Queensland hospitals during 2008-2016, we report age-standardized hospitalization rates/10,000 person-years, in-hospital case-fatality rate among these admissions (n = 30,327), and examine the factors associated with hospital deaths using logistic regression analyses.

Findings: Hospitalization rates increased from 8.50/10,000 (95% confidence interval (CI) 8.18-8.82) to 11.21/10,000 (95%CI 10.87-11.54) between 2008 and 2016, and peaked in men aged 55-59 years (34.03/10,000) and in Indigenous Australians (32.79/10,000). The number of admissions increased by 61.7% from 2701 admissions in 2008 to 4367 in 2016. During the same period, the percentage increase varied by socioeconomic disadvantage (3.2%/year in the most affluent vs. 9.4%/year in the most disadvantaged quintile; p < 0.001). Alcohol misuse was a contributing factor for cirrhosis in 55.1% of admissions, and socioeconomic disadvantage in 26.8%. The overall in-hospital case-fatality rate was 9.7% for males and 9.3% for females, and decreased in males (p < 0.001). Predictors of in-hospital mortality included hepatorenal syndrome (adjusted odds ratio (AOR) = 7.24, 95%CI 5.99-8.75), HCC (AOR = 2.53, 95%CI 2.20-2.91), hepatic encephalopathy (AOR = 1.94, 95%CI 1.61-2.34), acute peritonitis (AOR = 1.93, 95%CI 1.61-2.33), jaundice (AOR = 1.82, 95%CI 1.20-2.75), age ≥ 70 years (AOR = 1.63, 95%CI 1.38-1.92), a higher comorbidity index (p = 0.021), and residence outside of a "major city" (p < 0.001).

Interpretation: The increasing healthcare use by Australians with cirrhosis has resource and economic implications. Our data highlight the disproportionate impact of cirrhosis on Indigenous Australians and people from the most socioeconomically disadvantaged areas.

Funding: Brisbane Diamantina Health Partners.

Keywords: Adjusted odds ratios, AOR; Charlson Comorbidity Index, CCI; Chronic liver disease; Chronic liver diseases, CLDs; Confidence interval, CI; Epidemiology; Hepatic encephalopathy, HE; Hepatitis B virus, HBV; Hepatitis C virus, HCV; Hepatocellular carcinoma, HCC; In-hospital mortality; International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian, ICD-10-AM; Interquartile range, IQR; Least Absolute Shrinkage and Selection Operators, LASSO; Length of stay, LOS; Non-alcoholic fatty liver disease, NAFLD; Odds ratios, OR; Radio-frequency ablation, RFA; Temporal; Trans-arterial chemoembolization, TACE.