title: The impact of race and ethnicity on mortality and healthcare utilization in alcoholic hepatitis: a cross-sectional study.
abstract: BACKGROUND
  Alcoholic Hepatitis (AH) is major source of alcohol-related mortality and health care expenditures in the United States. There is insufficient information regarding the role of race and ethnicity on healthcare utilization and outcomes for patients with AH. We aimed to determine whether there are racial/ethnic differences in resource utilization and inpatient mortality in patients hospitalized with AH.
  
  
  METHODS
  We analyzed data from the Nationwide Inpatient Sample (NIS), years 2008-2011. We calculated demographic, clinical, and healthcare utilization characteristics by race. We then performed logistic regression and generalized linear modeling with gamma distribution (log link), respectively, to determine predictors of inpatient morality and total hospital costs (THC).
  
  
  RESULTS
  We identified 11,304 AH patients from 2008 to 2011. Mean age was 47.0 years, and 62.1 % were male, 61.9 % were white, 9.8 % were black, and 9.7 % were Hispanic. Mean LOS was 6.3 days and significantly longer in whites (6.5 d) than both blacks (5.4 d) and Hispanics (5.9 d). In adjusted models, inpatient mortality was lower for blacks than for whites (adj. OR = 0.50; 95 % CI = 0.32-0.78). THC was significantly higher for Hispanics than whites (fold increase = 1.25; 95 % CI = 1.01-1.49).
  
  
  CONCLUSIONS
  We identified differences in healthcare utilization and mortality by race/ethnicity. THC was significantly higher among Hispanics than for whites and blacks. We also demonstrated lower inpatient mortality in blacks compared to whites. These variations may implicate racial and ethnic differences in access to care, quality of care, severity of AH on presentation, or other factors.
authors.affiliation: Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 650 Charles E. Young Drive; Suite A2-125, Los Angeles, CA, 90095-6900, USA. fmay@mednet.ucla.edu.|Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA. fmay@mednet.ucla.edu.
authors.forename: Folasade P
authors.initials: FP
authors.lastname: May
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Vineet S
authors.initials: VS
authors.lastname: Rolston
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Elliot B
authors.initials: EB
authors.lastname: Tapper
authors.affiliation: Department of Pediatrics, Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Ashwini
authors.initials: A
authors.lastname: Lakshmanan
authors.affiliation: Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 650 Charles E. Young Drive; Suite A2-125, Los Angeles, CA, 90095-6900, USA.|Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Vinay
authors.initials: V
authors.lastname: Sundaram
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006519:Hepatitis, Alcoholic / Q000208:ethnology* / Q000401:mortality*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000208:ethnology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: Alcoholic hepatitis; Disparities; Healthcare utilization; Liver disease; Nationwide inpatient sample