S1324 Gender Disparities in Nonalcoholic Steatohepatitis Patients: Comparison of Patient Characteristics and Inhospital Outcomes

Abstract

Introduction: Nonalcoholic steatohepatitis (NASH) is the progressive form of Nonalcoholic Fatty Liver Disease (NAFLD). With the increasing trend in the prevalence of NASH in last decade, it has become important to study each and every aspect of the disease prevalence. Presence of gender disparities have been reported in NASH but there have not been enough studies about that, so we decided to evaluate gender disparities among patients with NASH. Methods: Adult male and female patients admitted with NASH, were analyzed from September 2015 to December 2020 using the National Inpatient Sample database. The primary outcome was to determine the burden of NASH in both subgroups. Secondary outcomes included all-cause in-hospital mortality, length of stay (LOS), and total hospital costs. SAS 9.4 software was used for statistical analysis. Results: Out of 435760 patients admitted with NASH, 2,69,980(62%) were female and 1,65,780(38%) were male. Median age in males is 61.3 ± 13 vs 62.2 ± 13.2 in females. Predominantly Caucasian Males and Females were reported compared to other ethnic groups. Comorbidities like hypertension, coronary artery disease, diabetes, peripheral vascular disease, A fib were higher in the male group compared to female. Only Obesity was reported slightly higher (37.2% vs 35.9%) in females. Higher in hospital mortality was observed (3.8% vs. 3.6%, P < 0.001) in male patients with NASH. Male subgroup demonstrated higher burden of A.fib (17.1% vs 12.6%) and VTE (1.8% vs 1.4%) compared to female subgroup. Inpatient hospital stay was found to be almost similar in both subgroups. We noted the cost of hospitalization is higher [18156$ ± 31336 vs. 15701$ ± 25255 p < 0.001] in males with NASH. Furthermore, our study showed increased need for acute/subacute rehab facility upon discharge (18.5% vs 15.1%) in female subgroup (Table). Conclusion: Our study suggests that incidence of NASH is much higher in Caucasian female despite less comorbidities. Higher in-hospital mortality and cost burden noted in males with NASH. Given the fact that NASH is currently second leading cause of liver transplantation overall and leading cause in female, aggressive risk reduction strategies and proactive screening approaches needs to be established. Table 1. - Gender Disparity in NASH patients hospitalized between September 2015 and December 2020 - Baseline characteristics, comorbidities and Outcomes Variables MaleN=165,780(38%) FemaleN=269,980(62%) P-Value Age, in years (Mean ± SD*) 61.3 ± 13 62.2 ± 13.2 0.001 Age groups, % < 0.001 18 - 40 years 7.5% 7.2% 41 – 60 years 35.2% 31.6% 61 – 80 years 52.6% 55.2% >80 years 4.8% 6% Race, % < 0.001 Caucasians 77.9% 72.7% African Americans 3.6% 4.6% Others 18.4% 22.7% Comorbidities, % Hypertension 63.5% 61.9% < 0.001 Diabetes mellitus 61.5% 61.2% 0.04 Congestive heart failure 22.9% 21.7% < 0.001 CAD* 29.9% 18.9% < 0.001 Peripheral vascular disease 5.5% 3.9% < 0.001 COPD* 18.2% 24.7% < 0.001 Renal failure 28.9% 26.3% < 0.001 Coagulopathy 34.3% 31.3% < 0.001 Obesity 35.9% 37.2% < 0.001 Drug abuse 2.4% 2.4% 0.39 Alcohol abuse 5.6% 2.5% < 0.001 Smoking 36.5% 29% < 0.001 Admission Type, % < 0.001 Emergent 87.8% 86.9% Elective 12.2% 13% Insurance type, % < 0.001 Medicare 53.7% 58.6% Medicaid 10% 13.1% Private 30.3% 23.7% Other 6% 4.6% Location/Teaching status of the hospital, % < 0.001 Rural 7% 8% Urban nonteaching 17.6% 18.7% Urban teaching 75.4% 73.3% Outcomes In-hospital mortality, % 3.8% 3.6% < 0.001 Mortality adjusted odds ratio 0.96(0.93 – 0.99) 0.01 Length of stay, in days (mean ± SD) 5.8 ± 7.2 5.7 ± 6.5 0.008 Total hospitalization cost, in US $ (mean ± SD) 18156 ± 31336 15701 ± 25255 < 0.001 Atrial fibrillation 17.1% 12.6% < 0.001 VTE* 1.8% 1.4% < 0.001 Disposition, % < 0.001 Discharge to home 58.9% 54.5% Transfer other: includes Skilled Nursing Facility, Intermediate Care Facility, or another type of facility 15.1% 18.5% Home health care 17.9% 19.9% Against medical advice 0.9% 0.6% *Abbreviations (NASH - Non-alcoholic steatohepatitis, SD - Standard deviation, CAD - Coronary artery disease, COPD - Chronic obstructive pulmonary disease, VTE - Venous Thromboembolism).