Race/Ethnicity and Insurance-Specific Disparities in In-Hospital Mortality Among Adults with Primary Biliary Cholangitis: Analysis of 2007–2014 National Inpatient Sample
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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.
KeywordsPrimary 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
Hepatitis C virus
Nonalcoholic fatty liver disease
Nationwide Inpatient Sample
Primary biliary cholangitis
Model for end-stage liver disease
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.
For this retrospective observational cohort study, informed consent was not required.
- 27.Yoshida EM, Mason A, Peltekian KM, et al. Epidemiology and liver transplantation burden of primary biliary cholangitis: a retrospective cohort study. Can Med Assoc J. 2018;6:e664–e670.Google Scholar