Key takeaways:
- Mortality in alcohol-associated hepatitis was highest among Native American and Hispanic individuals.
- Health care costs were higher among minority patients, women and those admitted to urban teaching hospitals.
CHICAGO — Sharp differences in mortality rates and costs related to alcohol-associated hepatitis before and after the COVID-19 pandemic highlight persistent demographic and socioeconomic disparities, according to a study.
Results of the retrospective cohort study showed disproportionate increases in mortality rates among Native American and Hispanic individuals, and higher hospital charges for women and patients admitted to urban teaching hospitals.
Sharp differences in mortality rates and costs related to alcohol-associated hepatitis before and after the COVID-19 pandemic highlight persistent demographic and socioeconomic disparities. Image: Adobe Stock.
The findings were presented at Digestive Disease Week.
Shubham Gupta
“Alcohol-induced hepatitis is now one of the leading causes of liver-related hospitalization, and it is becoming more lethal and expensive to treat,” Shubham Gupta, MD, study author and internal medicine resident at Virtua Health, told Healio. “The disparities we found in our analysis are part of a structural problem that cuts across most specialties. The same patients presenting with severe alcohol-induced hepatitis at age 35 are also at high risk for premature cardiovascular death, and we see that they tend to live in the same areas, see the same fragmented care, and face the same access barriers.
“The interventions that will matter the most are focused on fixing the equity infrastructure,” he added.
Gupta and colleagues used National Inpatient Sample data from 2016 to 2022 to assess disparities by race/ethnicity, sex, insurance coverage and geographic location among 907,390 people (median age, 48 years; 66% men) hospitalized with alcohol-associated hepatitis. More than half (52%) resided in the two lowest income quartiles.
In-hospital mortality served as the primary outcome. Secondary outcomes included length of stay and inflation-adjusted hospital charges. Analyses were adjusted for comorbidity burden, hospital factors and COVID-19 infection status. According to the study, alcohol-associated hepatitis hospitalizations steadily increased from 2016 to 2021 — rising from 583,399 to 822,148 — before dropping to 751,825 in 2022.
Results showed an in-hospital mortality rate of 4.2%, which increased from 3.9% before the COVID-19 pandemic (2016-2019) to 4.6% during and after COVID (2020-2022).
Mortality was highest among patients who identified as Native American (6.3%, adjusted OR = 1.31) or Hispanic (4.3%, aOR = 1.2) and lowest among Black patients (3.7%, aOR = 0.81) compared with white patients (4.2%).
“It is deeply concerning, but unfortunately not surprising,” Gupta said. “We noticed more alcohol-induced hepatitis admissions during COVID-19 among Native American, Hispanic and Asian/Pacific Islander populations who were already the most vulnerable before the pandemic.”
Women (aOR = 1.23) and patients who self-paid for care (aOR = 1.5), had private insurance (aOR = 1.4) or Medicaid (aOR = 1.28) also appeared to have higher mortality risk than those with Medicare.
The mean length of stay was 6.3 days, and nonsurvivors had longer stays (median, 6 days vs. 4 days). Patients admitted to urban teaching hospitals, women and underrepresented individuals had higher hospital charges compared with the median $36,533.
“While our MELD and Maddrey Discriminant scores focus on objective lab data, the social factors behind the patients — race, insurance type, geography — independently shape mortality and should be incorporated into risk stratification,” Gupta said. “The highest mortality is not seen at small community hospitals but instead at large urban teaching centers, presumably because the sickest patients end up there. This has implications for resource allocation, especially addiction medicine integration with early transplant referral pathways.
“Co-locating these core services could help in limiting further mortality and readmissions from alcohol-induced hepatitis,” he added.
For more information:
Shubham Gupta, MD, can be reached at shubg2024@gmail.com.
Sources/Disclosures
Source:
Ganju N, et al. Disparities in outcomes of alcohol-associated hepatitis in the United States: Insights from the National Inpatient Sample, 2016-2022. Presented at: Digestive Disease Week; May 2-5, 2026; Chicago.
Disclosures:
Gupta reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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