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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doaj-cca3095b9acb4c1393bc916b66347ce32020-11-25T00:44:42ZengElsevierEClinicalMedicine2589-53702019-05-01114453Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged AustraliansElizabeth E. Powell0Richard Skoien1Tony Rahman2Paul J. Clark3James O'Beirne4Gunter Hartel5Katherine A. Stuart6Steven M. McPhail7Rohit Gupta8Peter Boyd9Patricia C. Valery10Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, AustraliaDepartment of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, QLD, AustraliaGastroenterology & Hepatology Department, The Prince Charles Hospital, Chermside, QLD, AustraliaDepartment of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, AustraliaSunshine Coast University Hospital, Sunshine Coast, QLD, AustraliaQIMR Berghofer Medical Research Institute, Herston, QLD, AustraliaDepartment of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, AustraliaCentre for Functioning and Health Research, Queensland Health and the School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, AustraliaLogan Hospital, Meadowbrook, QLD, AustraliaCairns Base Hospital, Cairns, QLD, AustraliaQIMR Berghofer Medical Research Institute, Herston, QLD, Australia; Corresponding author.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. Keywords: Chronic liver disease, Epidemiology, Temporal, In-hospital mortalityhttp://www.sciencedirect.com/science/article/pii/S2589537019300859 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Elizabeth E. Powell Richard Skoien Tony Rahman Paul J. Clark James O'Beirne Gunter Hartel Katherine A. Stuart Steven M. McPhail Rohit Gupta Peter Boyd Patricia C. Valery |
spellingShingle |
Elizabeth E. Powell Richard Skoien Tony Rahman Paul J. Clark James O'Beirne Gunter Hartel Katherine A. Stuart Steven M. McPhail Rohit Gupta Peter Boyd Patricia C. Valery Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians EClinicalMedicine |
author_facet |
Elizabeth E. Powell Richard Skoien Tony Rahman Paul J. Clark James O'Beirne Gunter Hartel Katherine A. Stuart Steven M. McPhail Rohit Gupta Peter Boyd Patricia C. Valery |
author_sort |
Elizabeth E. Powell |
title |
Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians |
title_short |
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_sort |
increasing hospitalization rates for cirrhosis: overrepresentation of disadvantaged australians |
publisher |
Elsevier |
series |
EClinicalMedicine |
issn |
2589-5370 |
publishDate |
2019-05-01 |
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. Keywords: Chronic liver disease, Epidemiology, Temporal, In-hospital mortality |
url |
http://www.sciencedirect.com/science/article/pii/S2589537019300859 |
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