Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders

Abstract

INTRODUCTION: Chronic liver diseases (CLDs) and substance use disorders (SUDs) are increasingly prevalent and often coexist. Contemporary studies describing the characteristics and hospitalization trends of those with comorbid CLD-SUD are lacking. We aimed to characterize a population-based cohort with comorbid CLD-SUD and describe trends in these hospitalizations over time by individual-level characteristics. METHODS: We performed a cross-sectional analysis of the National Inpatient Sample from 2005 through 2017. Diagnosis codes were used to identify adult hospitalizations with CLD, SUD, or both. Bivariate and multivariate analyses were used to make comparisons between diagnosis categories. Unadjusted and age-adjusted trends in these hospitalizations were described over time. RESULTS: Of 401,867,749 adult hospital discharges, 3.2% had CLD-only and 1.7% had comorbid CLD-SUD. Compared with CLD-only, comorbid CLD-SUD hospitalizations resulted in higher inpatient mortality (3.1% vs 2.4%, P < 0.001) and were associated with younger age, male sex, Native American race, and urban and Western US location. Over time, comorbid hospitalizations grew 34%, and the demographics shifted with larger increases in hospitalization rates seen in younger individuals, women, Native Americans, and those publicly insured. In comorbid hospitalizations, alcoholic SUD and CLD decreased, but drug SUDs and nonalcoholic fatty liver diseases are fast-growing contributors. DISCUSSION: In this comprehensive analysis of US hospitalizations, comorbid CLD-SUD hospitalizations are increasing over time and lead to higher inpatient mortality than CLD alone. We further characterize the changing demographics of these hospitalizations, providing a contemporary yet inclusive look at comorbid CLD-SUD hospitalizations. These data can guide interventions needed to improve the poor outcomes suffered by this growing population.

The association between mental illness and all-cause mortality in patients with cirrhosis: a Veterans Affairs retrospective cohort study

“… 36 , 37 In regards to substance use, our study identified a recent rising incidence of AUD and SUD, which also mirrors national trends. 38 , 39 A recent cross-sectional analysis by Desai et al 40 evaluating US hospitalization trends found a rise in comorbid CLD-SUD hospitalizations resulting in higher rates of inpatient mortality than CLD alone, and during the COVID-19 pandemic there has been a rise in alcohol-associated hepatitis waitlistings and liver transplantation. 41 While we observed a parallel increase in the number of general mental health clinic visits per year in line with the rising incidence proportion of broad mental health diagnoses, there was a gradual decline in overall AUD/SUD-related visits despite a recent rising incidence proportion of AUD/SUD.…”

Trends in Racial and Ethnic Disparities in the Receipt of Lifesaving Procedures for Hospitalized Patients With Decompensated Cirrhosis in the US, 2009-2018

“…Data were obtained from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample database (NIS) between 2009 and 2018. The HCUP NIS has been extensively described elsewhere . This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.…”

“…All hospital discharges for individuals aged 18 years and older from 2009 to 2018 were assessed for inclusion. Admissions were included if they contained at least 1 cirrhosis-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and at least 1 cirrhosis-related complication ICD-9-CM or ICD-10-CM code (ie, ascites, HE, VH, and hepatorenal syndrome [HRS]) . eFigure 1 in Supplement 1 provides the flowchart of study participants.…”

“…). [9][10][11][12]14 eFigure 1 in Supplement 1 provides the flowchart of study participants. As the study spans the transition in the NIS sampling method in 2012, we used adjusted trend weights as recommended by HCUP.…”

Treatment of substance use disorders in patients with chronic liver disease

“…Notably, a recent national inpatient database analysis reports a disproportionate increase in hospitalizations for nonalcoholic fatty liver disease for those with comorbid CLD and SUD (74% in CLD alone vs. 320% in CLD and SUD) 19 . This highlights the evolving need for integrated and tailored care, with increasing SUD, obesity, and nonalcoholic fatty liver disease.…”