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Outcome of hospital care of liver disease associated with hepatitis C in the United States

Authors

  • W. Ray Kim M.D.,

    Corresponding author
    1. From the Outcomes Research Unit Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN
    • Division of Gastroenterology and Hepatology (Ch 10), Mayo Clinic and Foundation, 200 First Street, SW, Rochester, MN 55905. fax: 507-266-2810.
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    • W.R.K. is a recipient of the Career Development Award in Epidemiology and Outcomes from Hepatitis Foundation International.

  • John B. Gross Jr.,

    1. From the Outcomes Research Unit Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN
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  • John J. Poterucha,

    1. From the Outcomes Research Unit Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN
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  • G. Richard Locke III,

    1. From the Outcomes Research Unit Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN
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  • E. Rolland Dickson

    1. From the Outcomes Research Unit Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN
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Abstract

We describe mortality and resource utilization for inpatient care of hepatitis C (HCV) in comparison to alcohol-induced liver disease (ALD) in the United States and identify factors that affect outcomes. The Healthcare Cost and Utilization Project database, a national inpatient sample was used to identify hospitalization records with diagnoses related to liver disease from HCV and ALD. Outcome of hospitalizations was analyzed in terms of in-hospital deaths and health care resource utilization. For 1995, we estimate that there were 26,700 hospitalizations and 2,600 deaths in acute, nonfederal hospitals in the United States for liver diseases caused by HCV. Total charges for these hospitalizations were $514 million. In comparison, ALD was associated with 101,200 hospitalizations, 13,400 deaths, and $1.8 billion in charges. Simultaneous HCV and alcohol abuse was associated with younger ages at the time of hospitalization and death compared with HCV or ALD alone. In a logistic regression analysis, alcohol abuse (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-1.5) and human immunodeficiency virus (HIV) infection (OR, 4.5; 95% CI, 4.0-4.9) were associated with an increased risk of death among those with HCV. Liver transplantation and patient death were associated with the largest increase in hospitalization charges. Major complications of cirrhosis, such as variceal bleeding, encephalopathy, and hepatorenal syndrome, and sociodemographic factors, such as race and health insurance, were also significantly associated with the risk of death and hospitalization charges, which were similar in HCV and ALD. This study provides new estimates regarding the public health impact of HCV, for use in health policy decisions and cost-effectiveness analyses of preventive and therapeutic interventions.

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