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Hospitalizations for Autoimmune Hepatitis Disproportionately Affect Black and Latino Americans

The American Journal of Gastroenterology volume 113, pages 243253 (2018) | Download Citation

Subjects

Abstract

Objectives:

The healthcare burden of autoimmune hepatitis (AIH) in the United States has not been characterized. We previously showed that AIH disproportionately affects people of color in a single hospital system. The current study aimed to determine whether the same disparity occurs nationwide.

Methods:

We analyzed hospitalizations with a primary discharge diagnosis corresponding to the ICD-9 code for AIH in the National Inpatient Sample between 2008 and 2012. For each racial/ethnic group, we calculated the AIH hospitalization rate per 100,000 population and per 100,000 all-cause hospitalizations, then calculated a risk ratio compared to the reference rate among whites. We used multivariable logistic regression models to assess for racial disparities and to identify predictors of in-hospital mortality during AIH hospitalizations.

Results:

The national rate of AIH hospitalization was 0.73 hospitalizations per 100,000 population. Blacks and Latinos were hospitalized for AIH at a rate 69% (P<0.001) and 20% higher (P<0.001) than whites, respectively. After controlling for age, gender, payer, residence, zip code income, region, and cirrhosis, black race was a statistically significant predictor for mortality during AIH hospitalizations (odds ratio (OR) 2.81, 95% confidence interval (CI) 1.43, 5.47).

Conclusions:

Hospitalizations for AIH disproportionately affect black and Latino Americans. Black race is independently associated with higher odds of death during hospitalizations for AIH. This racial disparity may be related to biological, genetic, environmental, socioeconomic, and healthcare access and quality factors.

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Acknowledgements

The authors would like to acknowledge Janet Coffman, the UCSF Clinical and Translational Science Institute, and the UCSF Liver Center.

Author information

Affiliations

  1. Augusta University, Augusta, Georgia, USA

    • Jason W Wen
  2. Emory University School of Medicine, Atlanta, Georgia, USA

    • Jason W Wen
  3. UCSF Department of Epidemiology and Biostatistics, San Francisco, California, USA

    • Michael A Kohn
  4. Alameda Health Systems-Highland Hospital, Oakland, California, USA

    • Robert Wong
  5. UCSF Department of Medicine, San Francisco, California, USA

    • Ma Somsouk
    • , Mandana Khalili
    • , Jacquelyn Maher
    •  & Michele M Tana
  6. UCSF Liver Center, San Francisco, California, USA

    • Mandana Khalili
    • , Jacquelyn Maher
    •  & Michele M Tana

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Competing interests

Guarantor of the article: Michele M. Tana, MD.

Specific author contributions: Jason Wen: analysis and interpretation of data, drafting of manuscript, statistical analysis. Michael A. Kohn: critical revision of manuscript and statistical analysis. Robert Wong: critical revision of manuscript and statistical analysis. Ma Somsouk: critical revision of manuscript and statistical analysis. Mandana Khalili: critical revision of manuscript and statistical analysis. Jacquelyn Maher: critical revision of manuscript and statistical analysis. Michele Tana: study concept and design, acquisition of data, critical revision of manuscript and statistical analysis, study supervision.

Financial support: None.

Potential competing interests: None.

Corresponding author

Correspondence to Michele M Tana.

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DOI

https://doi.org/10.1038/ajg.2017.456