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Cost, burden of GI, liver, pancreatic diseases remain 'substantial' in US
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Recent data show that gastrointestinal, liver and pancreatic diseases continue to be sources of significant burden and cost in the U.S.
“Statistics quantifying the burden of GI diseases are valuable in public health research, decision making, priority setting, and resource allocation,” Anne F. Peery, MD, assistant professor at the University of North Carolina School of Medicine, and colleagues wrote.
Anne F. Peery
Peery and colleagues updated their previous report on the current state of GI and liver morbidity, mortality and cost in the U.S. using the most recent statistics from the CDC, the Agency for Healthcare Research and Quality and the National Cancer Institute, representing the years 2007 through 2012.
Symptoms, diagnoses in ambulatory settings
In 2010 the most common GI symptoms prompting an ambulatory visit included abdominal pain (more than 27 million), diarrhea (more than 5.6 million), vomiting (more than 5.4 million), nausea (more than 4.7 million), bleeding (more than 3.6 million), constipation (more than 3 million) and anorectal symptoms (more than 2.5 million).
The most frequent GI diagnoses in the ambulatory setting included abdominal pain (more than 16.6 million), GERD and reflux esophagitis (more than 7 million), hemorrhoids (almost 4 million) and constipation (more than 3.7 million).
ED visits
The most common GI discharge diagnoses from emergency departments in 2012 included abdominal pain (more than 5.7 million, a 27% increase since 2006), nausea and vomiting (more than 1.9 million, a 35% increase), noninfectious gastroenteritis/colitis (more than 1.2 million, a 24% decrease), constipation (almost 8,000,000, a 61% increase) and GI hemorrhage (almost 800,000, a 10% increase). More than 50% of GI hemorrhage diagnoses resulted in hospitalization and 1.3% resulted in death.
Nearly 1 million diagnoses of functional and motility disorders were made (a 39% increase), mostly for constipation. More than 288,000 liver disease and viral hepatitis diagnoses were made (a 24% increase), 65.1% of which resulted in hospitalization, and more than 125,000 IBD diagnoses were made (a 38% increase), 56.9% of which resulted in hospitalization.
Hospitalizations
The most common GI discharge diagnosis from hospital admissions in 2012 was GI hemorrhage (more than 507,000) with an aggregate cost of more than $4.8 billion. Hospitalizations for Clostridium difficile infection (more than 119,000) increased by 151% since 2003 with an aggregate cost of more than $1.1 billion. “Regardless of inflation, the increases in spending are statistically significant (P < .0001),” the researchers wrote.
Hospitalizations for chronic liver disease/viral hepatitis (more than 243,000) increased by 21% with an aggregate cost of more than $3.3 billion, and hospitalizations for IBD (more than 99,000) increased by 17% with an aggregate cost of more than $1 billion. Hospitalizations and charges have increased during the past two decades for both of these diagnoses, with significant spending increases regardless of inflation (P < .0001).
Cancer and mortality
In 2011 there were more than 1.1 million people living with colorectal cancer in the U.S., with more than 136,000 new cases diagnosed each year with a 65% 5-year survival rate. The most common causes of death from GI and liver diseases in 2012 included colorectal cancer (more than 51,000), pancreatic cancer (more than 38,000), liver and intrahepatic bile duct cancers (almost 23,000) and all-cause hepatic fibrosis/cirrhosis (more than 17,000; contributed to more than 34,000). C. difficile infection also caused 7,739 deaths in the same year.
Trends
According to the researchers, a key trend is related to the first baby boomers turning 65 years old in 2011. “This change in demographics is manifest in changes in liver disease in the United States,” including a 176% increase in hepatitis C-related ED visits from 2006 to 2012, and a 225% increase in hepatitis C admission from 2003 and 2012. “Other GI diagnoses associated with age are also increasing,” they wrote, including hemorrhoids, constipation, lower GI bleeding, acute diverticulitis and C. difficile infection.
Conversely, colorectal cancer incidence and mortality is decreasing in the U.S. due in part to increased screening, and despite therapeutic advances in IBD, hospitalizations and related charges have increased over the past two decades.
“As health care access expands, and the financing of [GI] services changes, researchers, clinicians, policy makers, and public health professionals now more than ever need a clear understanding of which conditions affect large portions of the population and the costs inherent in the care of them,” the researchers concluded. “GI, liver, and pancreatic diseases continue to account for substantial burden and cost in the United States.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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