Burden of cirrhosis on older Americans and their families: Analysis of the health and retirement study§

Authors

  • Mina O. Rakoski,

    Corresponding author
    1. Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
    • Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109-5362
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    • fax: 734-936-7392

  • Ryan J. McCammon,

    1. Division of Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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  • John D. Piette,

    1. Division of Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
    2. VA Ann Arbor Healthcare System Center for Clinical Management Research, Ann Arbor, MI
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  • Theodore J. Iwashyna,

    1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
    2. VA Ann Arbor Healthcare System Center for Clinical Management Research, Ann Arbor, MI
    3. Institute for Social Research, University of Michigan, Ann Arbor, MI
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  • Jorge A. Marrero,

    1. Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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  • Anna S. Lok,

    1. Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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  • Kenneth M. Langa,

    1. Division of Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
    2. VA Ann Arbor Healthcare System Center for Clinical Management Research, Ann Arbor, MI
    3. Institute for Social Research, University of Michigan, Ann Arbor, MI
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  • Michael L. Volk

    1. Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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  • Potential conflict of interest: Nothing to report.

  • Financial support provided by National Institutes of Health (NIH) T32 training grant DK62708 (to M.O.R.), NIH grant K23DK085204 and American Gastroenterology Research Scholar Award (to M.L.V.), NIH grant K08HL091249 (to T.J.I.), and NIH grant R01 AG030155 (to K.M.L.). John Piette is a VA Senior Research Career Scientist. The Health and Retirement Study is sponsored by the National Institute on Aging (U01 AG09740) and performed at the Institute for Social Research, University of Michigan.

  • §

    Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

Abstract

Prevalence of cirrhosis among older adults is expected to increase; therefore, we studied the health status, functional disability, and need for supportive care in a large national sample of individuals with cirrhosis. A prospective cohort of individuals with cirrhosis was identified within the longitudinal, nationally representative Health and Retirement Study. Cirrhosis cases were identified in linked Medicare data via ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes and compared to an age-matched cohort without cirrhosis. Two primary outcome domains were assessed: (1) patients' health status (perceived health status, comorbidities, health care utilization, and functional disability as determined by activities of daily living and instrumental activities of daily living), and (2) informal caregiving (hours of caregiving provided by a primary informal caregiver and associated cost). Adjusted negative binomial regression was used to assess the association between cirrhosis and functional disability. A total of 317 individuals with cirrhosis and 951 age-matched comparators were identified. Relative to the comparison group, individuals with cirrhosis had worse self-reported health status, more comorbidities, and used significantly more health care services (hospitalizations, nursing home stays, physician visits; P < 0.001 for all bivariable comparisons). They also had greater functional disability (P < 0.001 for activities of daily living and instrumental activities of daily living), despite adjustment for covariates such as comorbidities and health care utilization. Individuals with cirrhosis received more than twice the number of informal caregiving hours per week (P < 0.001), at an annual cost of US $4700 per person. Conclusion: Older Americans with cirrhosis have high rates of disability, health care utilization, and need for informal caregiving. Improved care coordination and caregiver support is necessary to optimize management of this frail population. (HEPATOLOGY 2012;55:184–191)

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