Compared with patients who have only chronic liver diseases (CLDs), hospitalizations among patients with comorbid CLDs and substance use disorders (SUDs) are increasing over time and leading to greater inpatient mortality, according to study results published in Clinical and Translational Gastroenterology.
Although CLDs and SUDs are commonly present together and increasing in the United States (US) within the last decade, there are still inadequate studies documenting outcomes in this patient population. Moreover, information about the contemporary traits of patients who are hospitalized with all-cause CLDs and SUDs over time is scarce.
To address this knowledge gap, a team of US-based investigators conducted a cross-sectional analysis to “study the characteristics of a population-based cohort with CLD and SUD and to describe hospitalization trends over time because of SUD and CLD by age group, race, and ethnicity.”
From 2005 to 2017, there were 401,867,749 adults discharged from hospitals. Of these, 3.2% had CLD-only and 7.1% had SUD-only, while 1.7% had comorbid CLD-SUD. Of the 6,929,801 patients with comorbid CLD-SUD who were discharged, the average age was 49.2 years, 31.5% were women, and 81.0% had public insurance.
Liver disease was due to alcohol in 49.8% of patients, hepatitis C virus (HCV) in 46.3% of patients, and cirrhosis in 39.4% of patients; 74% of patients had alcohol use disorder and 42.5% of patients had a drug use disorder.
Patients in the comorbid group were more likely to have alcohol-related and HCV-related liver diseases, as well as cirrhosis, compared with patients who only had CLD. Compared with CLD-only, comorbid CLD-SUD hospitalizations were negatively linked to increased age (adjusted odds ratio [aOR], 0.97) and Black, Hispanic, or Asian race/ethnicity (aORs, 0.80, 0.85, 0.85, respectively). Men (aOR, 3.74), Native Americans (aOR, 1.75), and patients with public insurance (aOR, 2.14) all had increased odds of comorbid CLD-SUD.
After age-adjustment, inpatient mortality was highest in the CLD-SUD comorbidity group (3.1%) compared with SUD-only (2.4%) and CLD-only (1.9%).
Alcohol use disorder was the major diagnosis group in patients with comorbid hospitalizations, although this use disorder decreased over time, while other drug use disorders increased by 10% since 2014. Although CLD-SUD hospitalizations increased in all age groups, except for those aged 36 to 50 years, the largest increase was noted among patients who were aged 18 to 35 years.
Comorbid rates among women also increased more than the rate for men. Comorbid hospitalization rates varied among races/ethnicities. However, the largest increase was noted among Native Americans (300%). Lastly, compared with private insurance (37%), CLD-SUD hospitalizations increased much more for patients who were under a public insurance plan (67%).
“Through understanding these trends, providers can more precisely deliver targeted interventions to improve the poor outcomes suffered by the growing population with both CLD and SUD,” the researchers noted. “These data also call for future studies looking into shared mechanisms of [nonalcoholic fatty liver disease] and SUD, which are increasingly affecting young, female, and ethnically diverse portions of the US population,” the authors concluded.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Desai AP, Greene M, Nephew LD, et al. Contemporary trends in hospitalizations for comorbid chronic liver disease and substance use disorders. Clin Transl Gastroenterol. 2021;12(6):e00372. doi:10.14309/ctg.0000000000000372