V. Sethi1, R. Bataller2, H. Liu3, K.M. Ruppert4, M. Molinari1 1University of Pittsburgh Medical Center, Surgery, Pittsburgh, PA, USA 2Hospital Clinic Barcelona, Hepatology, Barcelona, Spain 3Houston Methodist Hospital, Surgery, Houston, TX, USA 4University of Pittsburgh School of Public Health, Epidemiology, Pittsburgh, PA, USA
Introduction: Harmful alcohol use is not only rising among females, but females are also more prone to suffering from adverse effects of alcohol use as compared to males. Harmful alcohol use is associated with development of alcohol-associated liver disease (AALD) that includes fatty liver at one end of the spectrum to cirrhosis at the other end. Liver transplant (LT) is indicated in select patients with life-threatening AALD. We studied trends of AALD-associated hospitalizations and AALD-associated liver transplants (AALD-LT) in the United States from 2005 to 2021.
Methods: We used National (Nationwide) Inpatient Sample database of Healthcare Cost and Utilization Project from Agency for Healthcare Research and Quality to calculate weighted discharge data with ICD 9/10 diagnoses pertaining to AALD from 2005 to 2021. Scientific Registry of Transplant Recipients database was used to analyze AALD-LT from 2005 to 2021. Population data was derived from CDC-WONDER database. Individuals below 20 years of age were excluded. 40 years was the cut off to categorize males and females as younger or older. Incidence was calculated per 100,000 population for AALD-associated hospitalizations and per 1 million population for AALD-LT. ANOVA with Tukey's test was used for multiple comparisons of means and linear regression slopes; Fisher’s exact test was used to assess the association between AALD-LT and race or ethnicity. Two-tailed P < 0.05 was considered statistically significant.
Results: More than 100 million hospitalizations and 100,000 LT were analyzed. From 2005 to 2021, younger females had the highest relative increase in incidences of both AALD-associated hospitalizations and AALD-LT. For AALD-associated hospitalizations, relative increase in 2021 from 2005 was 283.2% in younger females, 169.1% in younger males, 77.3% in older females and 44.6% in older males. For AALD-LT, relative increase in 2021 from 2005 was 2263.4% in younger females, 713.6% in younger males, 257.0 in older females and 65.8% in older males (Figure 1).
In 2005, AALD was associated with 3.5% of all LT in younger females but this rose to 44.5% by 2021. For AALD-LT done in 2021, Model for End-Stage Liver Disease (MELD) score, indicating severity of sickness, was the second highest at 26.9 (SD 9.3) for younger females. In this demographic, during 2021, AALD-LT was associated with race but not with ethnicity.
Conclusion: This study provides evidence of an alarming trend in a younger demographic group previously infrequently associated with AALD or AALD-LT. The data has important public health and organ allocation policy implications and will engender additional studies analyzing the biopsychosocial factors at play behind these trends.