Pre-pandemic ED visits for alcohol-related hepatitis rose by 4.4% among younger patients
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Key takeaways:
- Although patients aged 45 to 65 years comprised the majority of ED visits, the greatest increase was reported in younger patients.
- Disease severity also increased, with most patients requiring hospitalization.
An analysis of ED utilization from 2016 to 2019 revealed an increase in visits for alcohol-associated hepatitis, particularly among patients aged 25 to 44 years, as well as an increase in disease severity.
“Alcohol-associated hepatitis (AH) is the most severe form of liver disease on the spectrum of alcohol-associated liver disease (ALD) with high short- and long-term mortality and morbidity,” Shreya Sengupta, MD, of the department of gastroenterology, hepatology & nutrition at the Cleveland Clinic, and colleagues wrote in Alcohol Clinical & Experimental. “Several studies have shown an increase in prevalence of ALD and AH in the U.S., U.K. and Canada, with 0.83% of all hospital admissions in the U.S. related to AH.”
They continued: “However, direct ED utilization for AH is not known.”
Using the Nationwide Emergency Department Sample dataset, Sengupta and colleagues investigated temporal trends and outcomes of 466,014,370 ED visits from 2016 to 2019. Of those, 448,984 (mean age, 47 years; 67% men) were for AH and 85% required hospitalization.
Although the total number of ED visits remained steady during the study period (115,991,385 to 117,266,903), the overall crude rate of AH climbed from 85 per 100,000 ED visits in 2016 to 106.8 per 100,000 visits in 2019.
Most visits (80.6%) were related to a secondary diagnosis of AH, while primary AH accounted for 19.4% of ED visits; however, researchers noted that secondary AH visits were “very likely linked” to a primary diagnosis of AH. Moreover, secondary AH visits increased at a higher rate compared with primary AH visits (68.6 to 86.5 per 100,000 vs. 16.4 to 20.3 per 100,000).
Researchers noted ED visits were most common among those aged 45 to 64 years (50.9%), followed by those aged 25 to 44 years (40.8%). However, the percentage of younger patients visiting the ED for AH increased during the study period by 4.4% (38.5% to 42.9%) and by 1.2% among those aged 65 years or older, while visits decreased among those aged 45 to 64 years.
Further, disease severity — including ascites, hepatic encephalopathy and acute kidney injury — increased over time. Medicaid (39.1%) was the most common payer for those seeking ED care for AH, while Medicare was the least common (14.4%).
“Our study using a large dataset in the United States shows an increase in ED visits for AH despite a stable number of total ED visits over the study period,” Sengupta and colleagues wrote. “Although patients in the age range of 45 to 64years comprised the majority of ED visits for AH, the number of ED visits for AH increased the most in younger patients aged 25 to 44years.”
They concluded: “These trends were present before the onset of the COVID-19 pandemic, which further fueled an increase in ALD.”
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