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. 2024 Feb 26;19(2):e0298887.
doi: 10.1371/journal.pone.0298887. eCollection 2024.

Increasing prevalence of cirrhosis among insured adults in the United States, 2012-2018

Daniela P Ladner  1   2 , Michael Gmeiner  3 , Bima J Hasjim  1 , Nikhilesh Mazumder  1   4 , Raymond Kang  5 , Emily Parker  6 , John Stephen  7 , Praneet Polineni  1 , Anna Chorniy  8 , Lihui Zhao  1   7 , Lisa B VanWagner  1   9 , Ronald T Ackermann  1   5 , Charles F Manski  1   10
Affiliations

Increasing prevalence of cirrhosis among insured adults in the United States, 2012-2018

Daniela P Ladner et al. PLoS One. .

Abstract

Background: Liver cirrhosis is a chronic disease that is known as a "silent killer" and its true prevalence is difficult to describe. It is imperative to accurately characterize the prevalence of cirrhosis because of its increasing healthcare burden.

Methods: In this retrospective cohort study, trends in cirrhosis prevalence were evaluated using administrative data from one of the largest national health insurance providers in the US. (2011-2018). Enrolled adult (≥18-years-old) patients with cirrhosis defined by ICD-9 and ICD-10 were included in the study. The primary outcome measured in the study was the prevalence of cirrhosis 2011-2018.

Results: Among the 371,482 patients with cirrhosis, the mean age was 62.2 (±13.7) years; 53.3% had commercial insurance and 46.4% had Medicare Advantage. The most frequent cirrhosis etiologies were alcohol-related (26.0%), NASH (20.9%) and HCV (20.0%). Mean time of follow-up was 725 (±732.3) days. The observed cirrhosis prevalence was 0.71% in 2018, a 2-fold increase from 2012 (0.34%). The highest prevalence observed was among patients with Medicare Advantage insurance (1.67%) in 2018. Prevalence increased in each US. state, with Southern states having the most rapid rise (2.3-fold). The most significant increases were observed in patients with NASH (3.9-fold) and alcohol-related (2-fold) cirrhosis.

Conclusion: Between 2012-2018, the prevalence of liver cirrhosis doubled among insured patients. Alcohol-related and NASH cirrhosis were the most significant contributors to this increase. Patients living in the South, and those insured by Medicare Advantage also have disproportionately higher prevalence of cirrhosis. Public health interventions are important to mitigate this concerning trajectory of strain to the health system.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: Dr. Lisa VanWagner serves as an advisor for Numares, Novo-Nordisk and Gerson Lehrman Group, receives grant support from W.L. Gore & Associates and provides expert witness services outside the submitted work. Other authors have no competing interests to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials

Figures

Fig 1
Fig 1. Prevalence of cirrhosis and HCC stratified by etiology.
ETOH = alcohol-related, HCV = hepatitis C virus, NASH = non-alcoholic steatohepatitis.
Fig 2
Fig 2. Prevalence of cirrhosis, and its etiologies, by age, gender, and insurance over time.
ETOH = alcohol-related, HCV = hepatitis C virus, NASH = non-alcoholic steatohepatitis.
Fig 3
Fig 3. US prevalence of insured Americans with cirrhosis between 2012–2018.
Prevalence of cirrhosis of insured Americans from 2012 to 2018 by state have progressively increased. “No data” refers to states with ≤70 patients with cirrhosis for the year.
See this image and copyright information in PMC

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