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IS THE BURDEN OF ALCOHOLIC LIVER DISEASE CHANGING? A CANADIAN EPIDEMIOLOGIC STUDY OF HOSPITALIZATIONS FROM 1994-2004
SJ Robbins1, AA Shaheen1, MF Liu2, RP Myers1
1Liver Unit, Division of Gastroenterology, University of Calgary; 2Health System Analysis Unit; Quality, Safety and Health Information; Calgary Health Region, Calgary, Alberta
BACKGROUND: Population-based data describing recent trends in the burden of alcoholic liver disease (ALD) in Canada are limited. Due to the rising burden of hepatitis C virus (HCV) and its frequent coexistence with ALD, we hypothesized that hospitalizations due to ALD may be increasing. Thus, the objective of our study was to describe temporal trends in ALD-related hospitalizations and predictors of increased health care utilization.
METHODS: We identified Calgary Health Region (CHR) residents hospitalized for ALD (ICD-9-CM and ICD-10 codes 571.1-571.3 and K70.0-K70.9, respectively) between 1998 and 2004 using a regional hospitalization database. The primary outcomes were liver-related ALD hospitalizations and total length of stay (LOS). Average annual growth rates in outcomes were calculated using Poisson regression and subgroup analyses conducted according to age, gender, ALD subtype (unspecified, alcoholic cirrhosis, alcoholic hepatitis) and HCV status.
RESULTS: Between 1994 and 2004, there were 5,211 ALD hospitalizations in the CHR; 62% were liver-related. Males (69%) and patients over 40 years (91%) accounted for the majority of admissions. Liver-related ALD hospitalizations decreased by 1.6% annually (95% CI 0.5-2.7%), with the greatest reductions observed in patients over 60 years (3.7%/yr [1.9-5.4%]). On the contrary, total LOS increased 2.2% per year (1.9-2.4%), suggesting a worsening in disease severity among hospitalized patients. While hospitalization rates in males decreased significantly (2.6%/yr [1.6-3.6%]), rates in females were stable (P=0.74). Hospitalization rates for alcoholic cirrhosis and alcoholic hepatitis both decreased significantly (P<0.05 for both). Finally, liver-related hospitalizations due to coexistent ALD and HCV, observed in 8% of the cohort, increased 14.4%/yr (10.1-18.8).
CONCLUSIONS: Hospitalization rates for ALD have decreased although the total burden of disease, as assessed by LOS, has increased slightly. The alarming growth in HCV disease burden extends to patients with coexistent ALD.