Chronic liver disease represents 'excessive burden' for individuals, health care system

Issue: June 2016

SAN DIEGO — Individuals with chronic liver disease were more likely to miss days of work and use health care services than those without chronic liver disease, according to findings presented at Digestive Disease Week 2016.

Maria Stepanova, PhD, of the Betty and Guy Beatty Center for Integrated Research at Inova Health System in Falls Church, Va., and colleagues, aimed to evaluate overall economic and individual patient experience burdens of chronic hepatitis in the U.S. Data from 10 cycles of the Medical Expenditure Panel Survey (MEPS, 2004-2013) underwent analysis. Variables included the employment status of patients, the number of disability days they took each year, limitations in daily activities and quality of life (QOL).

There were 230,406 participants included in the analysis. Chronic liver disease (CLD) was reported in 1,846 of those patients. The breakdown of that group was 36.7% with viral hepatitis, 5.3% with liver cancer and 3.9% with complications of cirrhosis, according to the results.

“The burden of CLD is not limited to morbidity and mortality,” Stepanova said. “Lower work productivity in patients with CLD is widely recognized and the total expenditures cost more than $2 billion annually. Our aim was to systematically assess the multiple components of the CLD burden.”

Patients with CLD were older than those without. The chronic disease patients also were less likely to have a university degree, more likely to have publicly sponsored insurance, earned less money and had components of metabolic syndrome, cardiac disease and cerebrovascular disease. Individuals with CLD were about four times less likely to report excellent health, and they also were less likely to report excellent mental health.

“The two groups were similar in terms of gender, race, marital status and BMI,” Stepanova said. “In general, comorbidities were two to four times higher in patients with CLD.” Some of those comorbidities included hypertension, heart disease, stroke, emphysema and diabetes.

Limitation in physical activities was reported by 34.0% of patients with CLD and 12.2% of those without (P < .0001). Work, home or school limitations were reported by 34.6% of individuals with CLD and 9.3% of those without, while social limitations (19.7% vs. 5.2%) and cognitive limitations (17.6% vs. 4.6%) were also more frequent in the CLD patients (P < .0001 for all comparisons).

Psychologic distress and depressive symptoms were more common in patients with CLD (P < .0001). “Psychologic distress was almost twice higher in CLD patients,” Stepanova said.

Employment rates were 44.7% for individuals with CLD and 69.6% for those without. Those with CLD also were more likely to not be working because of illness or disability (30.5% vs. 6.6%). Lost days of work due to disability were more common in the chronic disease group (3.8 vs. 1.5 days), while health care utilization and health care expenses were greater ($18,359 vs. $5,271 per year; P < .0001 for all comparisons).

“Inpatient stays were the primary driver of this increase in health care expenses,” Stepanova said.

Multivariable analysis results indicated that the presence of CLD predicted unemployment (OR = 0.59; 0.50-0.70) and greater yearly health care expenditures (β = $9,608 ± 1,891; P < .0001 for both comparisons). Other findings from this analysis indicated that both physical and mental QOL outcomes were impaired in patients with CLD (β = –4.0 ± 0.5 for both physical and mental components of SF-12; P < .0001 for both comparisons). “All of these differences were highly significant,” Stepanova said.

The most significant impact on employment was liver cancer (OR = 0.44; 0.20-0.99; P < .05). Other factors that impacted employment included health care expenditure (β=+$14,194 ± 7,287) and physical health impairment (β=-8.5 ± 2.1 to the physical component of SF-12; P < .05 for both comparisons).

Zobair Younossi MD, chairman of department of medicine at Inova Fairfax Hospital, Falls Church, VA, who is the senior author of this project, told Infectious Disease News: “CLD causes not only clinical burden but also economic burden and negative impact on patients’ experience. We must consider the comprehensive and multifaceted impact of CLD to bring the best outcomes to our patients and the society.”

For more information:

DeAvila L, et al. Abstract #230. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosures: Stepanova reports no relevant financial disclosures.

Editor's Note: This item has been updated to reflect Stepanova's correct title as well as additional commentary from Younossi.