S1260 Disparities Exist Among the Demographics of Patients with Alcohol-Related Hepatitis Who Leave Against Medical Advice

Abstract

Introduction: Alcohol-related hepatitis is one of the most severe manifestations of alcohol-related liver disease and has been associated with significant morbidity, mortality, and financial burden. Patients with alcohol use disorders are at risk of leaving against medical advice (LAMA), however there is lack of data in the literature to show which patients are at higher risk. In this study, we investigate and report the specific demographic factors and comorbidities associated with LAMA. Methods: Patients with a primary or secondary discharge diagnosis of alcohol-related hepatitis (ICD-10 codes K70.4 and K70.1) between January 2016 to December 2019 were included in this study. Demographics, comorbidities, complications, and interventions were studied for patients who LAMA. Multivariate analysis was conducted to elucidate factors contributing to the increased risk of alcohol-related hepatitis Results: A total of 538,750 patients were admitted with a diagnosis of alcohol-related hepatitis. Of these, 31,500 (5.84%) patients LAMA. Older age, Hispanic ethnicity, private insurance, and higher income status were associated with decreased risk of LAMA while younger age (aOR-4.39, p< 0.001), African American race (aOR-1.35, p< 0.001), lack of insurance (aOR-1.85, p< 0.001), and patients in the lowest income quartile (aOR-1.25, p< 0.001) were associated with the highest risk of LAMA. A concomitant diagnosis of hepatitis C (aOR-1.38, p< 0.001) or opioid use disorder (aOR-1.39, p-0.053) was also associated with higher risk of LAMA. A complete list of demographics and results of multivariate analysis are depicted in Table. Conclusion: Our findings demonstrate that significant differences exist between patients with alcohol-related hepatitis who leave against medical advice and those that remain hospitalized until discharge. We believe that this study will help healthcare providers identify patients at risk of LAMA and help promote targeted education of specific subgroups in understanding their disease state to decrease adverse events. Table 1. - Demographics and results of multivariate logistic regression to identify predictors for LAMA after adjusting for confounding variables Routine Discharge N (%) LAMAN (%) p-value Adjusted Odds Ratio p-value Total no. 507,250 31,500 Age Categories < 0.001 18-45 173,880 (34.2) 15,730 (50.0) 4.39 < 0.001 45-65 285,600 (56.3) 15,065 (47.8) 3.02 < 0.001 >65 47,770 (9.4) 705 (2.2) Reference Sex < 0.001 Male 338,540 (66.7) 22,845 (72.5) Reference Female 168,710 (33.3) 8,655 (27.5) 0.77 < 0.001 Race 0.003 White 356,935 (70.4) 21,910 (69.6) 1.3 < 0.001 African American 51,275 (10.1) 3,660 (11.6) 1.35 < 0.001 Hispanic 66,580 (13.1) 3,860 (12.3) Reference Asian/Pacific Islander 6,145 (1.21) 350 (1.1) 1.1 0.556 Native American 11,825 (2.3) 745 (2.4) 1.28 < 0.05 Other 14,490 (2.9) 975 (3.1) 1.16 0.093 Insurance < 0.001 Medicare 103,815 (20.5) 4,125 (13.1) 1.43 < 0.001 Medicaid 191,160 (37.7) 15,470 (49.1) 1.68 < 0.001 Private 131,675 (26) 5,405 (17.2) Reference Uninsured 56,815 (11.2) 4,990 (15.9) 1.85 < 0.001 Income Quartile < 0.001 Lowest quartile 141,480 (27.9) 9,940(31.6) 1.25 < 0.001 Second quartile 130,500 (25.7) 7,870 (25) 1.08 0.11 Third quartile 129,805 (25.6) 7,700 (24.4) 1.05 0.255 Highest quartile 105,465 (20.9) 5,995 (19.0) Reference Charlson Comorbidity Index < 0.001 0-1 188,205 (37.1) 16290 (51.7) 1.36 < 0.001 2 69165 (13.6) 5130 (16.3) 1.33 < 0.001 3 or more 249,880 (49.3) 10080 (32) Reference Comorbidities HIV/AIDS 1,715 (0.3) 155 (0.50) 0.0412 0.87 < 0.001 Hepatitis B 3,790 (0.75) 215 (0.7) 0.567 N/A Hepatitis C 45,120 (8.90) 3,650 (11.6) < 0.001 1.38 < 0.001 Opioid use disorder 1,525 (30.1) 225 (71.4) < 0.001 1.39 0.053 Drug use 71,780 (14.2) 7,340 (23.3) < 0.001 1.37 < 0.001 Smoking 11,500 (2.3) 915 (2.9) 0.009 1.13 0.116