The Changing Burden of Alcoholic Hepatitis: Rising Incidence and Associations with Age, Gender, Race, and Geography

Abstract

Alcoholic hepatitis is a major cause of morbidity and mortality. However, there are limited population-based data on its incidence, demographics, and temporal trends. We performed a retrospective cohort study using the State Inpatient Databases from Florida, Massachusetts, New York, and Washington from 2010 to 2014. We included patients aged 20-79 years admitted with alcoholic hepatitis and calculated incidence using population denominators obtained from the Centers for Disease Control and Prevention WONDER database. We fit multivariable Poisson regression models to explore interactions between alcoholic hepatitis incidence rates and several predictors including state, calendar year, age, race/ethnicity, and gender. Among 56,973 unique individuals with alcoholic hepatitis, the majority were male (39,702; 69.7%) and white non-Hispanic (40,934; 72.0%). In multivariable Poisson models, there was a significant interaction between calendar year and age group (p < 0.001), with the highest incidence rates in those ages 40-49 and 50-59 across all years. The absolute increase in incidence rate across calendar years was highest in the 20-29 and 30-39 age groups in every state. Female gender was associated with a lower rate (incidence rate ratio (IRR) 0.42, 95% confidence interval (CI) 0.41-0.42, p < 0.001). Compared to white non-Hispanics, black non-Hispanics (IRR 0.79, CI 0.77-0.81, p < 0.001) and Hispanics (0.66, CI 0.65-0.68, p < 0.001) had lower incidence rates. The incidence of alcoholic hepatitis in the USA varies by age, gender, race/ethnicity, and state of residence. The group with the fastest rising incidence is those aged 20-39. More work is needed to evaluate the reasons for the temporal trends for admissions for alcoholic hepatitis.

Keywords: Clinical epidemiology; Demographics; Liver transplant; Regional differences; Trends.