title: Impact of fatty liver disease on health care utilization and costs in a general population: a 5-year observation.
abstract: OBJECTIVE
  Fatty liver disease is a common condition in the Western world. Fatty liver may progress to steatohepatitis and cirrhosis. It is not yet known whether fatty liver disease results in higher health care utilization and costs.
  
  
  METHODS
  We used data from the Study of Health in Pomerania (SHIP), Germany, to assess the relation of fatty liver disease to self-reported health care utilization and costs at baseline and 5 years. The SHIP is a general population cohort study of 4310 adults aged 20 to 79 years at baseline in Pomerania. Fatty liver disease was defined as the presence of a hyperechogenic pattern of the liver and elevated serum alanine aminotransferase (ALT) levels.
  
  
  RESULTS
  In multivariable analyses, average annual overall health care costs at baseline and follow-up measurement were significantly higher for individuals with sonographic fatty liver and increased serum ALT levels. For example, controlling for comorbid conditions, subjects with sonographic fatty liver disease and increased serum ALT levels had 26% higher overall health care costs at 5-year follow-up. Analyses also suggest that diabetes and cardiovascular disease might mediate the relation of fatty liver disease and health care utilization and costs.
  
  
  CONCLUSIONS
  Policies seeking to minimize costs associated with fatty liver disease might want to consider addressing behavioral risk factors of fatty liver disease.
authors.affiliation: Institute of Epidemiology and Social Medicine, Medical School, University of Greifswald, Greifswald, Germany. baumeister@ift.de
authors.forename: Sebastian E
authors.initials: SE
authors.lastname: Baumeister
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.forename: Paul
authors.initials: P
authors.lastname: Marschall
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.forename: Carsten-Oliver
authors.initials: CO
authors.lastname: Schmidt
authors.forename: Steffen
authors.initials: S
authors.lastname: Flessa
authors.forename: Dietrich
authors.initials: D
authors.lastname: Alte
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005234:Fatty Liver / Q000191:economics* / Q000628:therapy*; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006304:Health Status; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008111:Liver Function Tests; D008875:Middle Aged; D013997:Time Factors