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Chronic Hepatitis B Is Associated with Higher Inpatient Resource Utilization and Mortality Versus Chronic Hepatitis C

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Abstract

Background

Chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections remain one of the leading causes of chronic liver disease and hepatocellular carcinoma. Healthcare initiatives for chronic viral hepatitis to facilitate early diagnosis and linkage to care in an effort to reduce inpatient resource utilization associated with late diagnosis and end-stage liver disease have been partially successful.

Aims

Our objective was to determine the impact of liver-related complications from chronic HBV and HCV infections on inpatient cost of care, length of stay, and mortality.

Methods

Using the Healthcare Cost and Utilization Project, National Inpatient Sample (HCUP-NIS), we studied the impact of chronic HBV and HCV infections on inpatient healthcare system following hospitalizations from 2003 to 2012.

Results

Of the 79,185,729 million hospitalizations among adult patients in the USA from 2003 to 2012, 143,896 (0.18 %) hospitalizations were HBV related and 1,073,269 (1.36 %) hospitalizations HCV related. HBV hospitalizations had a higher inpatient mortality (OR 1.34; 95 % CI 1.30, 1.38), median cost of care per hospitalization (+$2100.33; 95 % CI 1982.53, 2217.53), and increased length of hospitalization stay (+0.64 days; 95 % CI 0.60, 0.68; p < 0.01) compared to HCV.

Conclusions

Despite higher per case resource utilization following hospitalization, HBV-infected patients demonstrate a lower inpatient survival in comparison with chronic HCV infection. These disparate observations underscore the need for early diagnosis of chronic HBV infection in at-risk population and prompt linkage to care.

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Abbreviations

AIDS:

Acquired immune deficiency syndrome

AS:

Ascites

COG:

Coagulopathy

EVB:

Esophageal variceal bleeding

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCUP-NIS:

Healthcare Utilization Project National Inpatient Sample

HCV:

Hepatitis C virus

HE:

Hepatic encephalopathy

HRS:

Hepatorenal syndrome

ICD-9-CM:

International Classification of Diseases, 9th revision

LOS:

Length of stay

MF:

Malnutrition/failure to thrive

SBP:

Spontaneous bacterial peritonitis

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Author contributions

George Cholankeril was responsible for study concept and design, acquisition of the data, analysis and interpretation of the data, and drafting of the manuscript. Ryan Perumpail was responsible for acquisition of the data, analysis and interpretation of the data, and drafting of the manuscript. Menghan Hu was responsible for acquisition of the data and statistical analyses. Gail Skowron was responsible for critical revision of the manuscript for important intellectual content. Zobair Younossi was responsible for critical revision of the manuscript for important intellectual content. Aijaz Ahmed was responsible for study concept and design, interpretation of the data, study supervision, and critical revision of the manuscript for important intellectual content.

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Correspondence to George Cholankeril.

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All authors have no conflicts (financial, professional, or personal) of interest that are relevant to this manuscript.

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Cholankeril, G., Perumpail, R.B., Hu, M. et al. Chronic Hepatitis B Is Associated with Higher Inpatient Resource Utilization and Mortality Versus Chronic Hepatitis C. Dig Dis Sci 61, 2505–2515 (2016). https://doi.org/10.1007/s10620-016-4160-z

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  • DOI: https://doi.org/10.1007/s10620-016-4160-z

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