Increasing Hospitalization Rates for Cirrhosis: Overrepresentation of Disadvantaged Australians

Abstract

Background Limited information is available about hospitalization rates for cirrhosis in Australia. Methods Using information on all hospital episodes of care for patients admitted to Queensland hospitals during 2008–2016, we report age-standardized hospitalization rates/10,000 person-years, in-hospital case-fatality rate among these admissions (n = 30,327), and examine the factors associated with hospital deaths using logistic regression analyses. Findings Hospitalization rates increased from 8.50/10,000 (95% confidence interval (CI) 8.18–8.82) to 11.21/10,000 (95%CI 10.87–11.54) between 2008 and 2016, and peaked in men aged 55–59 years (34.03/10,000) and in Indigenous Australians (32.79/10,000). The number of admissions increased by 61.7% from 2701 admissions in 2008 to 4367 in 2016. During the same period, the percentage increase varied by socioeconomic disadvantage (3.2%/year in the most affluent vs. 9.4%/year in the most disadvantaged quintile; p < 0.001). Alcohol misuse was a contributing factor for cirrhosis in 55.1% of admissions, and socioeconomic disadvantage in 26.8%. The overall in-hospital case-fatality rate was 9.7% for males and 9.3% for females, and decreased in males (p < 0.001). Predictors of in-hospital mortality included hepatorenal syndrome (adjusted odds ratio (AOR) = 7.24, 95%CI 5.99–8.75), HCC (AOR = 2.53, 95%CI 2.20–2.91), hepatic encephalopathy (AOR = 1.94, 95%CI 1.61–2.34), acute peritonitis (AOR = 1.93, 95%CI 1.61–2.33), jaundice (AOR = 1.82, 95%CI 1.20–2.75), age ≥ 70 years (AOR = 1.63, 95%CI 1.38–1.92), a higher comorbidity index (p = 0.021), and residence outside of a “major city” (p < 0.001). Interpretation The increasing healthcare use by Australians with cirrhosis has resource and economic implications. Our data highlight the disproportionate impact of cirrhosis on Indigenous Australians and people from the most socioeconomically disadvantaged areas.