Race/Ethnicity and Insurance-Specific Disparities in In-Hospital Mortality Among Adults with Primary Biliary Cholangitis: Analysis of 2007–2014 National Inpatient Sample

  • Artin Galoosian
  • Courtney Hanlon
  • Michele Tana
  • Ramsey Cheung
  • Robert J. WongEmail author
Original Article



Primary biliary cholangitis (PBC) is a progressive autoimmune liver disease that can result in cirrhosis and end-stage liver disease.


We aim to evaluate hospitalization burden and in-hospital mortality among PBC patients in the USA.


Using data from the Nationwide Inpatient Sample from 2007 to 2014, hospitalizations among US adults with PBC were stratified by sex, age, and race/ethnicity. Overall in-hospital mortality was stratified by these variables and adjusted multivariate regression models evaluated for predictors of in-hospital mortality.


From 2007 to 2014, there were 18,279 hospitalizations among adults with PBC (15.0% male, mean age 63.8 years, 41.3% cirrhosis). Among non-Hispanic whites, the proportion of total PBC hospitalizations increased from 57.8% in 2007 to 71.2% in 2014, compared to 4.1–6.3% for African-Americans, 8.6–10.9% for Hispanics, and 1.7–2.8% for Asians (p < 0.001 for all). While overall in-hospital mortality was low (4.2%), increasing age was associated with higher odds of in-hospital mortality (OR: 1.02, 95% CI 1.01–1.03, p < 0.001). Compared to non-Hispanic white PBC patients, higher in-hospital mortality was observed in African-American PBC patients (OR: 1.40, 95% CI 1.16–2.03, p < 0.05). Compared to patients with private/commercial insurance, significantly higher odds of in-hospital mortality were observed in patients with Medicaid insurance (OR 1.42, 95% CI 1.00–1.99, p < 0.05).


In summary, among adults with PBC hospitalized in the USA from 2007 to 2014, the overall number of hospitalizations is increasing. Significant disparities in in-hospital mortality were observed; African-Americans with PBC and Medicaid patients with PBC have disproportionately higher odds of in-hospital mortality.


Primary biliary cholangitis Cirrhosis Mortality Hospitalizations Nationwide Inpatient Sample Race/ethnic disparities 



Agency for healthcare research and quality


Alcoholic liver disease


All patient-refined diagnosis-related group


Hepatocellular carcinoma


Hepatitis C virus


Hepatorenal syndrome


Nonalcoholic fatty liver disease


Nationwide Inpatient Sample


Primary biliary cholangitis


Ursodeoxycholic acid


Model for end-stage liver disease


Author’s contribution

AG contributed to the study concept and design, analysis and interpretation of data, writing of the manuscript, critical revision of the manuscript, study supervision. CH contributed to the analysis and interpretation of data, writing of the manuscript, critical revision of the manuscript. MT contributed to the analysis and interpretation of data, critical revision of the manuscript. RC contributed to the analysis and interpretation of data, critical revision of the manuscript. RW contributed to the study concept and design, analysis and interpretation of data, critical revision of the manuscript, study supervision.


No funding support was provided for this study. Robert Wong is supported by an AASLD Foundation Clinical and Translational Research Award in Liver Diseases.

Compliance with Ethical Standards

Conflict of interest

Artin Galoosian, Courtney Hanlon, Michele Tana, Benny Liu, Taft Bhuket: None. Ramsey Cheung: research grants: Gilead Sciences. Robert Wong: Advisory board, consultant, speaker’s bureau, and research grants: Gilead Sciences; research grant: Abbvie; speaker’s bureau: Salix.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this retrospective observational cohort study, informed consent was not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineCalifornia Pacific Medical CenterSan FranciscoUSA
  2. 2.Department of MedicineGeisel School of Medicine at DartmouthHanoverUSA
  3. 3.Department of MedicineKeck School of Medicine of USCLos AngelesUSA
  4. 4.Division of Gastroenterology and HepatologyUniversity of CaliforniaSan FranciscoUSA
  5. 5.Division of Gastroenterology and HepatologyUCSF—Zuckerberg San Francisco General Hospital, San Francisco General HospitalSan FranciscoUSA
  6. 6.Division of Gastroenterology and HepatologyStanford University School of MedicinePalo AltoUSA
  7. 7.Division of Gastroenterology and HepatologyAlameda Health SystemOaklandUSA

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