P1809 - The Epidemiology of Non-Alcoholic Steatohepatitis (NASH) in the United States Between 2010-2020: A Population-Based Study

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Osama Hamid, MD, MRCPI

Cleveland Clinic Foundation
Cleveland, OH, United States

Osama Hamid, MD, MRCPI¹, Abdul Mohammed, MD², Ahmed Eltelbany, MD, MPH¹, Imad Asaad, MD¹
¹Cleveland Clinic Foundation, Cleveland, OH; ²MetroHealth Medical Center, Cleveland, OH

Introduction: Non-alcoholic steatohepatitis (NASH) is a severe form of non-alcoholic fatty liver disease (NAFLD) that can progress to liver cirrhosis, liver failure and hepatocellular carcinoma. It is the second leading cause of liver transplant in the United States. This study aims at investigating the prevalence and demographics of patients with NASH in the United States using a large database.

Methods: We reviewed data from a large commercial database (Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Using systemized nomenclature of clinical medical terms (SNOMED CT) we identified adults with the diagnosis of NASH between 2010 to 2020. Demographic data including age, gender and race were collected. Risk factors known to be associated with NASH such as diabetes millets (DM), hyperlipidemia (HLD), Hypertension (HTN) and Obesity (defined as BMI >30) were also collected. Cochran-Armitage test was used to assess the statistical significance of year-by-year trend. Univariable and multivariable logistic regression was used to estimate the odds ratio (OR) of risk factors. We used R version 3.6.3 for statistical analysis.

Results: The annual prevalence rate has significantly increased from 1.51% in 2010 to 3.0% in 2020 (chi-square statistic 441441.19, P-value < 0.0001) (Figure 1). The proportion of patients with NASH by gender was consistent during this time period; approximately 54.1% Female vs 45.9% Male. Using Multivariable model, this difference was not found statistically significant (OR 1.04 [0.91-1.11]). Caucasian were found to have higher odds of having NASH in comparison with non-Caucasian (OR 1.42 [1.31-1.54]). As expected, NASH is strongly associated with DM and Obesity (OR 18.61 [17.35-19.94]) and (OR 20.97 [17.87-23.21]) respectively. Other components of metabolic syndrome were associated with NASH to a lesser degree; HTN (OR 3.24 [3.20-3.28]) and HLD (OR 4.93 [4.85-4.01]).

Discussion: The prevalence of NASH has significantly increased in the United States between 2010-2020. This is likely related to the increased prevalence of risk factors such as obesity and metabolic syndrome. It may reflect the improved strategy of diagnosing the disease.

Figure: Prevalence of NASH in the United States between 2010-2020

	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020
Cases	151200	217200	328800	501200	674400	1056000	184700	1879000	1913700	1978000	1867000
Total Cohort	10101000	13211000	18091000	24392000	33002000	44210000	60140000	60350000	61101000	61230000	62030000
Prevalence rate (%)	1.51	1.66	1.82	2.08	2.04	2.41	3.07	3.11	3.13	3.23	2.79
Age (%)
20-29	3.4	3.1	3.2	3.1	3.0	3.3	3.1	3.3	3.0	3.1	3.2
30-39	8.8	8.9	8.8	8.6	8.7	8.8	8.5	8.6	8.8	8.7	8.6
40-49	14.4	13.9	14.2	14.1	14.1	14.0	13.8	14.1	14.0	14.0	14.1
50-59	23.6	24.1	24.0	24.2	24.5	24.3	24.2	24.5	24.5	24.5	24.4
60-69	26.6	26.7	26.5	26.8	26.6	27.0	27.1	26.9	27.1	27.1	27.3
70-79	16.9	16.8	16.6	16.3	16.0	15.9	16.1	15.9	15.8	15.7	16.0
≥ 80	6.0	6.1	6.1	5.9	6.0	5.8	5.9	6.0	5.7	5.8	5.6
Gender (%)
Female	53.9	53.8	54.0	54.1	54.3	54.4	54.3	54.2	54.2	54.1	54.0
Male	46.1	46.2	46.0	45.9	45.7	45.6	45.7	45.8	45.8	45.9	46.0
Race (%)
Caucasian	78.1	78.2	79.9	79.9	80.1	80.2	80.0	80.2	80.3	80.2	80.2
Hispanic	11.2	11.1	10.3	10.2	10.1	9.9	9.9	10.0	10.2	10.2	10.2
African American	8.7	8.6	7.9	8.1	8.2	8.3	8.2	8.2	8.0	8.1	8.1
Other	2.0	2.1	1.9	1.8	1.6	1.6	1.6	1.6	1.5	1.5	1.5
Risk Factor (%)
DM	67.2	67.9	65.6	66.3	66.5	67.2	67.0	67.3	66.9	66.9	67.1
HTN	42.2	45.1	44.2	45.0	44.9	44.8	44.9	44.7	45.0	45.0	45.1
Obesity	62.0	61.3	62.1	62.3	62.1	62.8	62.9	62.9	62.8	62.8	62.7
HLD	50.1	48.2	48.9	50.2	50.1	50.2	50.1	49.9	50.2	50.2	50.1

Table: Demographics of NASH in the United States 2010-2020
DM: Diabetes Mellitus
HTN: Hypertension
HLD: Hyperlipidemia

Disclosures:

Osama Hamid indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Ahmed Eltelbany indicated no relevant financial relationships.

Imad Asaad indicated no relevant financial relationships.

Osama Hamid, MD, MRCPI¹, Abdul Mohammed, MD², Ahmed Eltelbany, MD, MPH¹, Imad Asaad, MD¹. P1809 - The Epidemiology of Non-Alcoholic Steatohepatitis (NASH) in the United States Between 2010-2020: A Population-Based Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.