1109 Ethnic and Geographic Variations for NAFLD-Related Hospitalizations

Abstract

INTRODUCTION: Non-Alcoholic fatty liver disease (NAFLD) is increasingly being recognized as an epidemic in the United States. We analyzed geographic patterns of hospitalized patients with NAFLD. Multiple factors are involved in NAFLD/NASH including genetic factors such as has been shown with GWAS studies identifying the PNPLA3 polymorphism which is increased in the Hispanic population. METHODS: This was a retrospective cohort study using the 2016 Nationwide Inpatient Sample (NIS) utilizing International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10 CM). All patients greater than 18 years of age with principal or secondary discharge diagnoses of NAFLD were included in the cohort. Comparisons were made between four geographic regions (northeast, south, Midwest and east) and between ethnicities (Caucasian, African American, Hispanics). Outcomes included incidence of NAFLD-related admissions, in-hospital mortality, length of stay (LOS) and total hospitalization charges. Proportions were compared using fisher’s exact test and continuous variables using student t-test. Multivariable and Poisson regressions were performed for length of stay and hospitalization charges. All statistics were performed utilizing STATA software. RESULTS: A total of 109,634 discharges had principal or secondary diagnoses of NAFLD for the year 2016. Of these, 19,815 (18%) were in the Northeast, 18,340 (16.7%) in the Midwest, 46,214 (42.15%) were noted in the South, whereas 25,264 (23%) were identified in the East as shown in Table 1. 62% were Caucasians, 10% were African Americans, while 18% were Hispanics. Table 2 shows ethnic differences. The Hispanic population was significantly younger with an increased predominance in males and was disproportionately present in all four regions. Diabetes Mellitus was more significantly associated with NAFLD in the South and African-Americans. The length of stay was significantly shorter in the East (3.03 days vs 3.53 days in Northeast, P < 0.001. These findings persisted after adjustment for confounders. CONCLUSION: Our study does show differences in hospitalization related to NAFLD during the year 2016 in terms of cost and length of stay. NAFLD-related hospitalizations were more common in the South. Further studies are needed to elucidate the reasons for the predominance of NAFLD in the South and the Hispanic population.