E0472 - Disparities Exist Among the Demographics of Patients with Alcohol-Related Hepatitis Who Leave Against Medical Advice

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Aalam Sohal, MD

UCSF Fresno
Fresno, CA

Aalam Sohal, MD¹, Hunza Chaudhry, MD², Kanwal Bains, MBBS³, Armaan Dhaliwal, MBBS⁴, Gagan Gupta, MBBS⁵, Piyush Singla, MBBS⁶, Raghav Sharma, MBBS⁷, Dino Dukovic, ⁸, Marina Roytman, MD¹
¹UCSF Fresno, Fresno, CA; ²UCSF-Fresno, Fresno, CA; ³Brigham and Women’s Hospital, Boston, MA; ⁴University of Arizona, Tucson, AZ; ⁵Dayanand Medical College and Hospital, Phillaur, Punjab, India; ⁶Dayanand Medical College and Hospital, Ludhiana, Punjab, India; ⁷Punjab Instute of Medical Sciences, Jalandhar, Jalandhar, Punjab, India; ⁸Ross University School of Medicine, Anaheim, CA

Introduction: Alcohol-related hepatitis is one of the most severe manifestations of alcohol-related liver disease and has been associated with significant morbidity, mortality, and financial burden. Patients with alcohol use disorders are at risk of leaving against medical advice (LAMA), however there is lack of data in the literature to show which patients are at higher risk. In this study, we investigate and report the specific demographic factors and comorbidities associated with LAMA.

Methods: Patients with a primary or secondary discharge diagnosis of alcohol-related hepatitis (ICD-10 codes K70.4 and K70.1) between January 2016 to December 2019 were included in this study. Demographics, comorbidities, complications, and interventions were studied for patients who LAMA. Multivariate analysis was conducted to elucidate factors contributing to the increased risk of alcohol-related hepatitis

Results: A total of 538,750 patients were admitted with a diagnosis of alcohol-related hepatitis. Of these, 31,500 (5.84%) patients LAMA. Older age, Hispanic ethnicity, private insurance, and higher income status were associated with decreased risk of LAMA while younger age (aOR-4.39, p< 0.001), African American race (aOR-1.35, p< 0.001), lack of insurance (aOR-1.85, p< 0.001), and patients in the lowest income quartile (aOR-1.25, p< 0.001) were associated with the highest risk of LAMA. A concomitant diagnosis of hepatitis C (aOR-1.38, p< 0.001) or opioid use disorder (aOR-1.39, p-0.053) was also associated with higher risk of LAMA. A complete list of demographics and results of multivariate analysis are depicted in Table 1.

Discussion: Our findings demonstrate that significant differences exist between patients with alcohol-related hepatitis who leave against medical advice and those that remain hospitalized until discharge. We believe that this study will help healthcare providers identify patients at risk of LAMA and help promote targeted education of specific subgroups in understanding their disease state to decrease adverse events.

	Routine Discharge N (%)	LAMA N (%)	p-value	Adjusted Odds Ratio	p-value
Total no.	507,250	31,500
Age Categories			< 0.001
18-45	173,880 (34.2)	15,730 (50.0)		4.39	< 0.001
45-65	285,600 (56.3)	15,065 (47.8)		3.02	< 0.001
>65	47,770 (9.4)	705 (2.2)		Reference
Sex			< 0.001
Male	338,540 (66.7)	22,845 (72.5)		Reference
Female	168,710 (33.3)	8,655 (27.5)		0.77	< 0.001
Race			0.003
White	356,935 (70.4)	21,910 (69.6)		1.3	< 0.001
African American	51,275 (10.1)	3,660 (11.6)		1.35	< 0.001
Hispanic	66,580 (13.1)	3,860 (12.3)		Reference
Asian/Pacific Islander	6,145 (1.21)	350 (1.1)		1.1	0.556
Native American	11,825 (2.3)	745 (2.4)		1.28	< 0.05
Other	14,490 (2.9)	975 (3.1)		1.16	0.093
Insurance			< 0.001
Medicare	103,815 (20.5)	4,125 (13.1)		1.43	< 0.001
Medicaid	191,160 (37.7)	15,470 (49.1)		1.68	< 0.001
Private	131,675 (26)	5,405 (17.2)		Reference
Uninsured	56,815 (11.2)	4,990 (15.9)		1.85	< 0.001
Income Quartile			< 0.001
Lowest quartile	141,480 (27.9)	9,940(31.6)		1.25	< 0.001
Second quartile	130,500 (25.7)	7,870 (25)		1.08	0.11
Third quartile	129,805 (25.6)	7,700 (24.4)		1.05	0.255
Highest quartile	105,465 (20.9)	5,995 (19.0)		Reference
Charlson Comorbidity Index			< 0.001
0-1	188,205 (37.1)	16290 (51.7)		1.36	< 0.001
2	69165 (13.6)	5130 (16.3)		1.33	< 0.001
3 or more	249,880 (49.3)	10080 (32)		Reference
Comorbidities
HIV/AIDS	1,715 (0.3)	155 (0.50)	0.0412	0.87	< 0.001
Hepatitis B	3,790 (0.75)	215 (0.7)	0.567	N/A
Hepatitis C	45,120 (8.90)	3,650 (11.6)	< 0.001	1.38	< 0.001
Opioid use disorder	1,525 (30.1)	225 (71.4)	< 0.001	1.39	0.053
Drug use	71,780 (14.2)	7,340 (23.3)	< 0.001	1.37	< 0.001
Smoking	11,500 (2.3)	915 (2.9)	0.009	1.13	0.116

Table: Demographics and results of multivariate logistic regression to identify predictors for LAMA after adjusting for confounding variables.

Disclosures:

Aalam Sohal indicated no relevant financial relationships.

Hunza Chaudhry indicated no relevant financial relationships.

Kanwal Bains indicated no relevant financial relationships.

Armaan Dhaliwal indicated no relevant financial relationships.

Gagan Gupta indicated no relevant financial relationships.

Piyush Singla indicated no relevant financial relationships.

Raghav Sharma indicated no relevant financial relationships.

Dino Dukovic indicated no relevant financial relationships.

Marina Roytman indicated no relevant financial relationships.

Aalam Sohal, MD¹, Hunza Chaudhry, MD², Kanwal Bains, MBBS³, Armaan Dhaliwal, MBBS⁴, Gagan Gupta, MBBS⁵, Piyush Singla, MBBS⁶, Raghav Sharma, MBBS⁷, Dino Dukovic, ⁸, Marina Roytman, MD¹. E0472 - Disparities Exist Among the Demographics of Patients with Alcohol-Related Hepatitis Who Leave Against Medical Advice, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.