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The Impact of Race and Sex on the Clinical Outcomes of Homeless Patients With Alcoholic Liver Disease: Propensity Score Matched Analysis of US Hospitals.
- Source :
-
Journal of clinical gastroenterology [J Clin Gastroenterol] 2024 Aug 01; Vol. 58 (7), pp. 708-717. Date of Electronic Publication: 2024 Aug 01. - Publication Year :
- 2024
-
Abstract
- Background: Among patients with alcoholic liver disease (ALD), homelessness poses significant medical and psychosocial risks; however, less is known about the effects of race and sex on the hospital outcomes of admitted homeless patients with ALD.<br />Methods: The National Inpatient Sample database from 2012 to 2017 was used to isolate homeless patients with ALD, and the cohort was further stratified by race and sex for comparisons. Propensity score matching was utilized to minimize covariate confounding. The primary endpoints of this study include mortality, hospital length of stay, and hospital costs; secondary endpoints included the incidence of liver complications.<br />Results: There were 3972 females/males postmatch, as well as 2224 Blacks/Whites and 4575 Hispanics/Whites postmatch. In multivariate, there were no significant differences observed in mortality rate, length of stay, and costs between sexes. Comparing liver outcomes, females had a higher incidence of hepatic encephalopathy [adjusted odds ratio (aOR) 1.02, 95% CI: 1.01-1.04, P <0.001]. In comparing Blacks versus Whites, Black patients had higher hospitalization costs (aOR 1.13, 95% CI: 1.03-1.24, P =0.01); however, there were no significant differences in mortality, length of stay, or liver complications. In comparing Hispanics versus Whites, Hispanic patients had longer length of hospital stay (aOR 1.12, 95% CI: 1.06-1.19, P <0.001), greater costs (aOR 1.15, 95% CI: 1.09-1.22, P <0.001), as well as higher prevalence of liver complications including varices (aOR 1.04, 95% CI: 1.02-1.06, P <0.001), hepatic encephalopathy (aOR 1.03, 95% CI: 1.02-1.04, P <0.001), and hepatorenal syndrome (aOR 1.01, 95% CI 1.00-1.01, P =0.03). However, there was no difference in mortality between White and Hispanic patients.<br />Conclusions: Black and Hispanic ALD patients experiencing homelessness were found to incur higher hospital charges; furthermore, Hispanic patients also had greater length of stay and higher incidence of liver-related complications compared with White counterparts.<br /> (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Middle Aged
United States epidemiology
Sex Factors
Adult
Hispanic or Latino statistics & numerical data
Incidence
Hospitalization statistics & numerical data
Aged
Retrospective Studies
White People statistics & numerical data
Black or African American statistics & numerical data
Hospital Mortality ethnology
Databases, Factual
Hepatic Encephalopathy epidemiology
Hepatic Encephalopathy ethnology
Hepatic Encephalopathy etiology
Liver Diseases, Alcoholic ethnology
Liver Diseases, Alcoholic mortality
Liver Diseases, Alcoholic epidemiology
Propensity Score
Ill-Housed Persons statistics & numerical data
Length of Stay statistics & numerical data
Hospital Costs statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1539-2031
- Volume :
- 58
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of clinical gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 37983807
- Full Text :
- https://doi.org/10.1097/MCG.0000000000001919