The high burden of alcoholic cirrhosis in privately insured persons in the United States

Mellinger, Jessica L.; Shedden, Kerby; Winder, Gerald Scott; Tapper, Elliot B.; Adams, Megan A.; Fontana, Robert J.; Volk, Michael L.; Blow, Frederic C.; Lok, Anna S.

doi:10.1002/hep.29887

Cited by 171 publications

(169 citation statements)

References 38 publications

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“…Cirrhotic and noncirrhotic ALD prevalence has been estimated at approximately 2% in the general US population, whereas AC in the US Veterans' population was estimated at 327 per 100,000 enrollees . In privately insured US patients, AC has been estimated at approximately 100 per 100,000 enrollees, and, overall, rates are projected to rise over time . Worldwide, AC deaths account for about 10% of all alcohol‐attributable deaths, and nearly half of those deaths are due to liver disease, resulting in the loss of 22.2 million disability‐adjusted life years annually .…”

Section: Prevalence and Burden Of Alcohol‐associated Liver Diseasementioning

confidence: 99%

“…In the United States, ALD competes with chronic HCV as the leading indication for liver transplantation (LT) . Medical costs are high for AC, driven in part by the higher number of admissions for these patients . In addition, deaths related to alcohol use are frequently underestimated due to the stigma of alcohol use and lack of candor in reporting .…”

Section: Prevalence and Burden Of Alcohol‐associated Liver Diseasementioning

confidence: 99%

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Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

et al. 2020

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Section: Prevalence and Burden Of Alcohol‐associated Liver Diseasementioning

confidence: 99%

Section: Prevalence and Burden Of Alcohol‐associated Liver Diseasementioning

confidence: 99%

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

et al. 2020

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“…Cirrhosis is common, affecting up to 5 million Americans, and its prevalence is increasing . It is characterized by poor quality of life and life‐limiting complications such as variceal hemorrhage, ascites, hepatic encephalopathy (HE), and hepatocellular carcinoma (HCC) . There are standard measures that can be undertaken to forestall many of these complications and improve patient outcomes.…”

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confidence: 99%

The Quality and Outcomes of Care Provided to Patients with Cirrhosis by Advanced Practice Providers

et al. 2019

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Cirrhosis is morbid and increasingly prevalent, yet the U.S. health care system lacks enough physicians and specialists to adequately manage patients with cirrhosis. Although advanced practice providers (APPs) can expand access to cirrhosis‐related care, their impact on the quality of care remains unknown. We sought to determine the effect on care quality and outcomes for patients managed by APPs using a retrospective analysis of a nationally representative American commercial claims database (Optum), which included 389,257 unique adults with cirrhosis. We evaluated a complication of process measures (i.e., rates of hepatocellular carcinoma [HCC] screening, endoscopic varices screening, and use of rifaximin after hospitalization for hepatic encephalopathy) and outcomes (30‐day readmissions and survival). Compared with patients without APP care, patients with APP care had higher rates of HCC screening (adjusted odds ratio [OR] 1.23, 95% confidence interval 1.19, 1.27), varices screening (OR 1.20 [1.13, 1.27]), use of rifaximin after a discharge for hepatic encephalopathy (OR 2.09 [1.80, 2.43]), and reduced risk of 30‐day readmission (OR 0.68 [0.66, 0.70]). Gastroenterology/hepatology consultation was also associated with improved quality metric performance compared with primary care; however, shared visits between gastroenterologists/hepatologists and APPs were associated with the best performance and lower 30‐day readmissions compared with subspecialty consultation without an APP (OR 0.91 [0.87, 0.95]. Multivariate analysis adjusting for comorbidities, liver disease severity, and other factors including gastroenterology/hepatology consultation showed that patients seen by APPs were more likely to receive consistent HCC and varices screening over time, less likely to experience 30‐day readmissions, and had lower mortality (adjusted hazard ratio 0.57, 95% confidence interval 0.55, 0.60). Conclusion: APPs, particularly when working with gastroenterologists/hepatologists, are associated with improved quality of care and outcomes for patients with cirrhosis.

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“…First, there is potential for inaccurate coding that could lead to misclassification bias of CLD status, measurement bias for covariates of interest, and ascertainment bias for clinical outcomes. However, prior studies using our coding algorithm for CLD status has demonstrated good sensitivity and specificity and a positive predictive value of 80% or greater . In addition, while we attempted to reduce confounding of opiate use due to surgery by removing patients with anaesthesia codes, the outpatient pharmacy file does not provide context for the indication of opiate use.…”

Section: Discussionmentioning

confidence: 99%

Prescription opioid use is common and associated with worse clinical outcomes in individuals with chronic liver disease

et al. 2020

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Summary Background Prescription opioid use is highly prevalent and associated with increased morbidity and mortality. Clinical implications of use in chronic liver disease(CLD) remains poorly characterised. Aims Assess prevalence and clinical impact of opioid use in patients with CLD. Methods We conducted a retrospective cohort study using Marketscan to compare correlates and clinical outcomes of opioid use among patients with and without CLD. Patients were classified into categories based on opioid prescription claims in the 12‐month period prior to index: non‐use, naïve‐use and prior‐use. Multivariable logistic regression and Cox regression with a time‐dependent covariate were used to assess correlates of opioid use and clinical outcomes including index hospitalisation, total admissions, hospital days, cost of hospitalisation and in‐hospital mortality. Results Over a median follow‐up of 38 (IQR 25‐54) months among 587 445 adults (n = 71 402 CLD and 516 043 non‐CLD), prescription opioid use (naïve‐use and prior‐use) was significantly higher among CLD than non‐CLD patients (60% vs 41.8%, P < .001). Opioid exposure increased risk of clinical outcomes in both CLD and non‐CLD patients (admissions IRR 2.71, 95% CI 2.67‐2.76; hospital days IRR 3.00,95% CI 2.93‐3.08; total cost IRR 3.13, 95% CI, 2.97‐3.31; in‐hospital mortality IRR 5.80, 95% CI 5.17‐6.50). Associations between opiate use and clinical outcomes were greater among CLD than non‐CLD patients (interaction P < .05 in each model). Conclusions Prescription opioid use is higher among patients with CLD and associated with higher rates, duration and cost of hospitalisation and in‐hospital mortality. Interventions to curb opioid use in CLD are needed to improve healthcare utilisation and clinical outcomes.

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The high burden of alcoholic cirrhosis in privately insured persons in the United States

Abstract: In a nationally representative cohort of privately insured persons, AC enrollees were disproportionately sicker at presentation, were admitted and readmitted more often, and incurred nearly double the per-person health care costs compared to those with non-AC. (Hepatology 2018).

Cited by 171 publications

References 38 publications

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

The Quality and Outcomes of Care Provided to Patients with Cirrhosis by Advanced Practice Providers

Prescription opioid use is common and associated with worse clinical outcomes in individuals with chronic liver disease

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