The burgeoning growth in cirrhosis-related hospitalization in Australia, 2008-2016

Background and aims:While chronic liver disease is a major global public health problem, it has not been recognized as a National Health Priority Area in Australia. A population-based study using hospital admission data for cirrhosis in the large state of Queensland, Australia during 2008-2016 was performed. Method:Hospital data on all patient admissions (public and private)and deaths during 2008-2016 in the state of Queensland were obtained. Queensland is a large state in the north-east of Australia with a population of 4.9 million. We identified all hospital admissions for cirrhosis for patients aged 20 years or older. We reported age-standardized hospitalization rates/10, 000 person-years by gender and per calendar year, in-hospital case fatality rate among these admissions (n = 30, 327) and examined the factors associated with hospital deaths. Results:Age-adjusted hospitalization rates increased by 32%between 2008 and 2016, from 8.50/10, 000 (95%CI 8.18-8.82) to11.21/10, 000 (95%CI 10.87-11.54). Admission rates peaked in men at34.03/10, 000 in 55-59 year-olds. The age-standardized admission rate for Indigenous Australians was 32.79/10, 000 (95%CI 31.28-34.31). Alcohol misuse was a contributing factor in over half (55.1%) of all admissions, and in 26.8% of admissions patients resided in most socio-economically disadvantaged areas. The overall in-hospital case fatality rate was 9.7% for males and 9.3% for females, and decreased significantly in males from 10.25% in 2008 to 8.32% in 2016 (p <0.001). Admissions associated with hepatorenal syndrome (AOR =7.24, 95%CI 5.99-8.75), HCC (AOR = 2.53, 95%CI 2.20-2.91), hepatic encephalopathy (AOR = 1.94, 95%CI 1.61-2.34), acute peritonitis (AOR= 1.93, 95%CI 1.61-2.33), jaundice (AOR = 1.82, 95%CI 1.20-2.75) andage≥70 years (AOR = 1.63, 95%CI 1.38-1.92) were significantly associated with in-hospital mortality. A higher Charlson comorbidity index (p = 0.021), longer length of hospitalization (p < 0.001) and residence