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Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians

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-ho...

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Autores principales: Powell, Elizabeth E., Skoien, Richard, Rahman, Tony, Clark, Paul J., O'Beirne, James, Hartel, Gunter, Stuart, Katherine A., McPhail, Steven M., Gupta, Rohit, Boyd, Peter, Valery, Patricia C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610783/
https://www.ncbi.nlm.nih.gov/pubmed/31317132
http://dx.doi.org/10.1016/j.eclinm.2019.05.007
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author Powell, Elizabeth E.
Skoien, Richard
Rahman, Tony
Clark, Paul J.
O'Beirne, James
Hartel, Gunter
Stuart, Katherine A.
McPhail, Steven M.
Gupta, Rohit
Boyd, Peter
Valery, Patricia C.
author_facet Powell, Elizabeth E.
Skoien, Richard
Rahman, Tony
Clark, Paul J.
O'Beirne, James
Hartel, Gunter
Stuart, Katherine A.
McPhail, Steven M.
Gupta, Rohit
Boyd, Peter
Valery, Patricia C.
author_sort Powell, Elizabeth E.
collection PubMed
description 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.
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spelling pubmed-66107832019-07-17 Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians Powell, Elizabeth E. Skoien, Richard Rahman, Tony Clark, Paul J. O'Beirne, James Hartel, Gunter Stuart, Katherine A. McPhail, Steven M. Gupta, Rohit Boyd, Peter Valery, Patricia C. EClinicalMedicine Research Paper 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. Elsevier 2019-06-13 /pmc/articles/PMC6610783/ /pubmed/31317132 http://dx.doi.org/10.1016/j.eclinm.2019.05.007 Text en © 2019 Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Paper
Powell, Elizabeth E.
Skoien, Richard
Rahman, Tony
Clark, Paul J.
O'Beirne, James
Hartel, Gunter
Stuart, Katherine A.
McPhail, Steven M.
Gupta, Rohit
Boyd, Peter
Valery, Patricia C.
Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians
title Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians
title_full Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians
title_fullStr Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians
title_full_unstemmed Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians
title_short Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians
title_sort increasing hospitalization rates for cirrhosis: overrepresentation of disadvantaged australians
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610783/
https://www.ncbi.nlm.nih.gov/pubmed/31317132
http://dx.doi.org/10.1016/j.eclinm.2019.05.007
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