title: The burden of cirrhosis and impact of universal coverage public health care system in Thailand: Nationwide study.
abstract: OBJECTIVE
  Cirrhosis is responsible for significant health-care costs and morbidity. This study aims to evaluate the burden of illness associated with cirrhosis, its impact on the universal coverage public health care system in Thailand.
  
  
  METHODS
  We used data from the 2010 Nationwide Hospital Admission Data, the National Health Security Office (NHSO), Thailand. Their baseline characteristics, hospital costs, and outcomes were analyzed according to national health insurance categories including medical welfare scheme (MWFS), social security scheme (SSS) and civil servant medical benefit scheme (CSMBS).
  
  
  RESULTS
  92,301 admissions were eligible for analysis. The mean age was 55 ± 12.8 years, and 63.3% of patients were above 50 years old. The majority of patients (79%) belonged to the MWFS group. The MWFS group incurred the lowest medical expense and had the shortest hospital stay compared to the SSS and CSMBS groups. Overall in-hospital mortality was 10.7%. Cirrhosis complications include bleeding esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome, and hepatocellular carcinoma. These complications significantly increased mortality rates compared to patients without complications (26 vs. 8.9%, p < 0.001). In-hospital mortality of patients with cirrhosis complications did not differ among the three national health insurance groups. Respiratory failure and septicemia were associated with the highest risk of death (HR 5.4; 95% CI: 4.8-5.9 and HR 5.2; 95% CI: 4.9-5.6 respectively; P < 0.001).
  
  
  CONCLUSIONS
  Illness associated with cirrhosis is a significant public health problem in Thailand. Outcomes of cirrhosis complications did not differ between universal public health care coverage systems in Thailand.
authors.affiliation: Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Kittiyod
authors.initials: K
authors.lastname: Poovorawan
authors.affiliation: Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Sombat
authors.initials: S
authors.lastname: Treeprasertsuk
authors.affiliation: Clinical Epidemiology Unit, Faculty of Medicine, KhonKaen University, Thailand.
authors.forename: Kaewjai
authors.initials: K
authors.lastname: Thepsuthammarat
authors.affiliation: Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Polrat
authors.initials: P
authors.lastname: Wilairatana
authors.affiliation: Vichaiyut Hospital and Medical Center, Thailand.
authors.forename: Bubpha
authors.initials: B
authors.lastname: Kitsahawong
authors.affiliation: Vichaiyut Hospital and Medical Center, Thailand.
authors.forename: Kamthorn
authors.initials: K
authors.lastname: Phaosawasdi
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D017150:Public Sector / Q000191:economics*; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors; D019472:Universal Health Insurance / Q000191:economics*; D055815:Young Adult