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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




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.


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.


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).


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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  1. 1.

    , , et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999;31:929–938.

  2. 2.

    , . Advances in the diagnosis, pathogenesis, and management of autoimmune hepatitis. Gastroenterology 2010;139:58–72.e54.

  3. 3.

    , , . Autoimmune hepatitis in Denmark: incidence, prevalence, prognosis, and causes of death. A nationwide registry-based cohort study. J Hepatol 2014;60:612–617.

  4. 4.

    , , et al. Autoimmune hepatitis in African Americans: presenting features and response to therapy. Am J Gastroenterol 2001;96:3390–3394.

  5. 5.

    , , et al. Autoimmune hepatitis in Mexican patients. J Clin Gastroenterol 2013;47:372.

  6. 6.

    , , et al. Characteristics of autoimmune hepatitis in patients who are not of European Caucasoid ethnic origin. Gut 2002;50:713–717.

  7. 7.

    , , et al. The impact of race/ethnicity on the clinical epidemiology of autoimmune hepatitis. J Clin Gastroenterol 2012;46:155–161.

  8. 8.

    . Challenges in the diagnosis and management of autoimmune hepatitis. Can J Gastroenterol 2013;27:531–539.

  9. 9.

    , , et al. Autoimmune hepatitis in a North American Aboriginal/First Nations population. Can J Gastroenterol 2008;22:829–834.

  10. 10.

    , , . The impact of ethnicity on the natural history of autoimmune hepatitis. Hepatology 2007;46:1828–1835.

  11. 11.

    , , et al. Nationwide Inpatient Sample (NIS) Redesign Final Report. 2014. HCUP Methods Series Report # 2014-04 ONLINE. April 4, 2014. U.S. Agency for Healthcare Research and Quality, Available at .

  12. 12.

    , . Validity of the recording of ischaemic heart disease and chronic obstructive pulmonary disease in the Saskatchewan health care datafiles. Stat Med 1995;14:2627–2643.

  13. 13.

    , , . Validation of hospital discharge diagnosis data for chronic obstructive pulmonary disease and other allied conditions. Am J Public Health 1986;76:803–805.

  14. 14.

    , , et al. ICD-10 hospital discharge diagnosis codes were sensitive for identifying pulmonary embolism but not deep vein thrombosis. J Clin Epidemiol 2010;63:790–797.

  15. 15.

    , , et al. Validation of coding algorithms for the identification of patients with primary biliary cirrhosis using administrative data. Can J Gastroenterol 2010;24:175–182.

  16. 16.

    , , . Coding algorithms for identifying patients with cirrhosis and hepatitis B or C virus using administrative data. Pharmacoepidemiol Drug Saf 2015;24:107–111.

  17. 17.

    , , et al. Inpatient burden of constipation in the United States: an analysis of national trends in the United States from 1997 to 2010. Am J Gastroenterol 2014;109:250–256.

  18. 18.

    , , . Hepatitis A hospitalizations in the United States, 2002-2011. Hepatology 2015;61:481–485.

  19. 19.

    , , . Early transjugular intrahepatic portosystemic shunt in US patients hospitalized with acute esophageal variceal bleeding. J Gastroenterol Hepatol 2017;32:852–858.

  20. 20.

    , , et al. Weekend vs. weekday admissions for cholangitis requiring an ERCP: comparison of outcomes in a National Cohort. Am J Gastroenterol 2016;111:405–410.

  21. 21.

    , , et al. Incidence and prevalence of autoimmune hepatitis in the area of the Hospital de Sagunto (Spain). Gastroenterol Hepatol 2004;27:239–243.

  22. 22.

    , , et al. Hepatology outpatient service provision in secondary care: a study of liver disease incidence and resource costs. Clin Med 2007;7:119–124.

  23. 23.

    , , . Hospitalizations And costs associated with hepatitis C and advanced liver disease continue to increase. Health Affairs 2014;33:1728–1735.

  24. 24.

    , , et al. The inpatient economic and mortality impact of hepatocellular carcinoma from 2005 to 2009: analysis of the US nationwide inpatient sample. Liver Int 2013;33:1281–1286.

  25. 25.

    , , et al. Access to primary care is associated with better autoimmune hepatitis outcomes in an urban county hospital. BMC Gastroenterol 2015;15:91.

  26. 26.

    , , et al. Race: a critical factor in organ donation, patient referral and selection, and orthotopic liver transplantation? Liver Transplant Surg 1998;4:499–505.

  27. 27.

    , , . Racial disparities in the management of hospitalized patients with cirrhosis and complications of portal hypertension: A National Study. Hepatology 2007;45:1282–1289.

  28. 28.

    , , et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health 2015;105:e60–e76.

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

Author information


  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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