P2822 - Differences in Epidemiology, Outcomes and Healthcare Utilization Amongst White, African American and Hispanic Patients With Cirrhosis: A National Database Study

Syed Ali Amir Sherazi, MD¹, Hemant Goyal, MD, PGDCA (MBA)², Attar Bashar, MD¹, Melchor Demetria, MD^1
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ²Wright Center for Graduate Medical Education, Scranton, PA

Introduction: Racial disparities in healthcare are well documented. A previous national study focused on admitting hospital characteristics in patients solely admitted with decompensated cirrhosis showed no difference in mortality by race (J Racial Ethn Health Disparities 2017;4(2):243-51). Our study assessed prevalence of epidemiological differences, outcomes and healthcare utilization of cirrhosis by race in all admissions from a national database

Methods:
The US Healthcare Cost & Utilization Project’s National Inpatient Sample (HCUP-NIS) 2016-2018 was queried to identify patients with cirrhosis using ICD-10 codes. We studied patient and hospital demographics, comorbidities, cirrhosis etiologies, complications, mean length of stay (mLOS), mean Total Hospital Charges (mTHC), all-cause mortality for White (WH), African American (AA) and Hispanic (HISP) patients. Statistical analysis utilized chi-square test, univariate and multinomial logistic regression






Results:
Of all inpatients with cirrhosis, 1,459,494 were WH, 247,375 AA and 363,370 HISP. HISP were youngest (mean age 58.5 yrs vs 59.1 AA, 61.2 WH, p< 0.001) with least women (36.6% vs 41.4% AA, 41% WH, p< 0.0001). AA and HISP were treated at large, urban teaching hospitals and more on Medicaid compared to WH (all p< 0.0001). AA had highest mLOS (6.9 days vs 6.0 HISP, 6.1 WH, p< 0.001) while HISP had highest mTHC ($80,256 vs $71,297 AA, $66,016 WH, p< 0.001, adjusted for patient and hospital demographics). Cirrhosis etiologies showed Hepatitis B/C highest in AA, Alcoholism/alcoholic cirrhosis highest in HISP while NASH/NAFLD highest in WH. All cirrhosis complications were highest in HISP and lowest in AA (all p< 0.001) (Table1). Rates of HCC were similar in HISP and AA (p< 0.0001) while hepatic transplant was lowest in AA (p=0.001). Rates of medical co-morbidities were mixed- HISP with highest rates of diabetes, WH with highest hypertension, dyslipidemia, COPD, smoking, obesity while AA with highest CAD, heart failure and CKD (all p< 0.0001). Mortality was highest in AA (adjusted for patient and hospital demographics, medical co-morbidities (p< 0.001)






Discussion: The current analysis, the largest to date, shows significant racial disparities with Hispanics having the highest rates of cirrhosis complications and mTHC while AA had highest mLOS and adjusted mortality despite lowest prevalence of cirrhosis complications. This raises the question whether AA patients with cirrhosis face more barriers to timely access to care, thereby delaying care

Cirrhosis Complication	WH (%)	AA (%)	HISP (%)	p-value
Portal hypertension	26.7	18.2	29.1	< 0.0001
Esophageal varices	17.9	12.1	21.5	< 0.0001
Variceal UGI Bleed	4.6	3.0	6.4	< 0.0001
Portal Gastropathy	8.6	5.4	10.4	< 0.0001
SBP	3.0	2.3	3.5	< 0.0001
Portal Vein Thrombus	2.6	2.4	2.8	< 0.0001
Hepatic Failure	23.0	18.5	25.6	< 0.0001
Hepato-renal Syndrome	4.1	3.3	4.3	< 0.0001
Hepatocellular cancer	3.9	5.9	5.9	< 0.0001
Hepatic Transplant	0.7	0.5	0.7	0.001

Table: Table 1- Cirrhosis Complications


Disclosures:
Syed Ali Amir Sherazi indicated no relevant financial relationships.
Hemant Goyal indicated no relevant financial relationships.
Attar Bashar indicated no relevant financial relationships.
Melchor Demetria indicated no relevant financial relationships.


Syed Ali Amir Sherazi, MD¹, Hemant Goyal, MD, PGDCA (MBA)², Attar Bashar, MD¹, Melchor Demetria, MD¹. P2822 - Differences in Epidemiology, Outcomes and Healthcare Utilization Amongst White, African American and Hispanic Patients With Cirrhosis: A National Database Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.