Digestive and liver diseases statistics, 2004

BACKGROUND & AIMS: Digestive and liver diseases are associated with substantial morbidity and mortality in the United States. Statistics about the incidence, prevalence, mortality, and resource utilization of digestive and liver diseases in the United States may be cumbersome to obtain because they are scattered in multiple sources. These data may be useful for policy makers, grant applicants, and authors. METHODS: Data on the most common gastrointestinal and liver diseases were collected from large publicly available national databases. Information was collected on inpatient and outpatient gastrointestinal complaints and diagnoses, gastrointestinal cancers, and deaths from common liver diseases. RESULTS: The leading gastrointestinal complaint prompting an outpatient visit is abdominal pain, with 12.2 million annual visits, followed by diarrhea, nausea, and vomiting. Abdominal pain is the leading outpatient gastrointestinal diagnosis, accounting for 5.2 million visits annually, followed by gastroesophageal reflux disease, with 4.5 million visits. Gallstone disease is the most common inpatient diagnosis, with 262,411 hospitalizations and a median inpatient charge of USD$11,584. Colorectal cancer is the most common gastrointestinal cause of death and is the most common gastrointestinal cancer, with an incidence of 54 per 100,000. Among gastrointestinal cancers, primary liver cancer had the highest increase in incidence from 1992 to 2000. CONCLUSIONS: Gastrointestinal and liver diseases are associated with significant outpatient and inpatient healthcare utilization. Following trends in utilization is important for determining allocation of resources for health care and research.     

US national estimation of emergency department utilization by patients given 'HIV/AIDS-related illness' as their primary diagnosis

Background

The emergency department (ED) is one of the most frequent sources of medical care for many HIV‐infected individuals. However, the characteristics and ED utilization patterns of patients with HIV/AIDS‐related illness as the primary ED diagnosis (HRIPD) are unknown.

Methods

We identified the ED utilization patterns of HRIPD visits from a weighted sample of US ED visits (1993–2005) using the National Hospital Ambulatory Medical Care Survey, a nationally representative survey. Data on visits by patients≥18 years old were analysed using procedures for multiple‐stage survey data. We compared the utilization patterns of HRIPD vs. non‐HRIPD visits, and patterns across three periods (1993–1996, 1997–2000 and 2001–2005) to take into account changes in HIV epidemiology.

Results

Overall, 492 000 HRIPD visits were estimated to have occurred from 1993 to 2005, corresponding to 5‐in‐10 000 ED visits. HRIPD visits experienced longer durations of stay (5.2 h vs. 3.4 h; P=0.001), received more diagnostic tests (5.1 vs. 3.3; P<0.001), were prescribed more medications (2.5 vs. 1.8; P<0.001) and were more frequently seen by physicians (99.5%vs. 93.8%; P<0.001) compared with non‐HRIPD visits. HRIPD visits were more likely to result in admission [adjusted odds ratio (OR) 7.67; 95% confidence interval (CI) 5.14–11.44]. The proportion of HRIPD visits that required emergent/urgent care or were seen by attending physicians, and the number of diagnostic tests ordered, significantly increased over time (P<0.05), while the wait time (P=0.003) significantly decreased between the second and third study periods (P<0.05).

Conclusions

Although HRIPD visits were infrequent relative to all ED visits, HRIPD visits utilized significantly more resources than non‐HRIPD visits and the utilization also increased over time.     

Resource utilization associated with irritable bowel syndrome in the United States 1987-1997

This study uses national databases to examine the impact of irritable bowel syndrome (IBS) on resource utilization in the United States. Approximately 1.5–2.7 million physician visits (599–1043 per 100,000) yearly were related to IBS, with 45.3% seen by gastroenterologists, and 89% prescribed medications. Rates of physician visits by women were approximately 2.4–3.3 times higher than that for men. The average number of medication prescribed per visit was 1.83. Approximately 89% of the visits were prescribed with medications. The rate of hospitalization (5.1 per 100,000 in 1997) decreased by 60% and length of stay decreased from 5.5 to 3.1 days in the past decade. The average charges of IBS-related hospitalization were US$7,882. Our study found an apparent decreasing trend of IBS-related hospitalizations and no marked increase in office consultations in the past decade. However, a better case identification criterion is necessary to estimate the true disease burden.     

Coronary Revascularization and Cardiac Catheterization in the United States: Trends in Racial Differences

Objectives. We sought to determine whether racial differences in rates of coronary artery bypass graft surgery (CABG), percutaneous transluminal coronary angioplasty (PTCA) and cardiac catheterization decreased after 1980.

Background. Many reports of racial differences in utilization of CABG have been published since 1982. However, changes in the relative utilization of revascularization over time have received little attention.

Methods. Data from the National Hospital Discharge Survey were examined for the years 1980 through 1993. Estimated numbers of procedures performed in nonfederal U.S. hospitals were used to compute age-adjusted rates per 100,000 population by year and race for patients 35 to 84 years old.

Results. In patients 35 to 84 years old, the rate of CABG increased in blacks and whites between 1980 and 1993. Between 1986 and 1993, there was little change in the black/white ratio of age-adjusted rates (0.23 in 1980 through 1985 combined, 0.38 in 1986 and 0.43 in 1993). An apparent increase from 0.23 in 1980 through 1985 combined may have been due to sampling variation. Despite rapid increases in rates of PTCA in both races, no increase in the black/white ratio was noted (0.57 in 1993). However, the rate of inpatient cardiac catheterization increased more rapidly in blacks than in whites. This resulted in an increase in the black/white ratio of age-adjusted rates from 0.42 in 1980 to 0.91 in 1993.

Conclusions. Rates of CABG, cardiac catheterization and especially PTCA increased between 1980 and 1993, a period during which racial disparities in the procedures became widely known. Despite apparent increases in the black/white ratio for inpatient cardiac catheterization, large racial disparities in the utilization of CABG and PTCA persist and require further evaluation and possible intervention.

(J Am Coll Cardiol 1997;29:1557–62)     

Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States

BACKGROUND & AIMS: Based on experimental and epidemiologic studies, we investigated whether coffee and caffeine consumption reduced the risk of elevated alanine aminotransferase (ALT) activity in persons at high risk for liver injury in a national, population-based study. METHODS: Participants were 5944 adults in the Third US National Health and Nutrition Examination Survey, 1988-1994, with excessive alcohol consumption, viral hepatitis, iron overload, overweight, or impaired glucose metabolism. Liver injury was indicated by abnormal serum ALT activity (>43 U/L). RESULTS: Elevated ALT activity was found in 8.7% of this high-risk population. In unadjusted analysis, lower ALT activity was associated with increasing consumption of coffee ( P = .001) and caffeine ( P = .001). Multivariate logistic regression analyses showed that the risk of elevated ALT activity declined with increasing intake of coffee ( P for trend = .034) and caffeine ( P < .001). Comparing persons who drank more than 2 cups per day with noncoffee drinkers, the odds ratio was .56 (95% confidence interval, .31-1.0). Comparing persons in the highest caffeine quintile with the lowest, the odds ratio was .31 (95% confidence interval, .16-.61). These relationships were consistent across subgroups at risk for liver injury and were relatively unchanged when analyses included the entire population or when limited to persons without impaired liver function or right upper quadrant pain. Fasting insulin concentrations did not mediate the effects. CONCLUSIONS: In this large, national, population-based study, among persons at high risk for liver injury, consumption of coffee and especially caffeine was associated with lower risk of elevated ALT activity.     

Public health impact of colonoscopy use on colorectal cancer mortality in Germany and the United States

1. Download high-res image (188KB)
2. Download full-size image

     

Coffee and tea consumption are associated with a lower incidence of chronic liver disease in the United States

BACKGROUND & AIMS: Coffee drinking has been suggested to protect against liver injury, but it is uncertain whether this is of clinical significance. We examined the relationship of coffee and tea consumption with the incidence of hospitalization or death from chronic liver disease (CLD). METHODS: Participants in the population-based, first National Health and Nutrition Examination Survey, 1971-1975, were asked about coffee and tea consumption, which was categorized as <1 cup (mean, 0.2 cups), 1 to 2 cups, and >2 cups per day (mean, 4.0 cups). A second analysis included persons who, in 1982-1984, were asked more detailed questions on coffee and tea drinking. Participants were followed through 1992-1993 for a hospital or death certificate diagnosis of CLD or cirrhosis (ICD-9-CM 571). Hazard rate ratios for CLD according to coffee and tea intake were calculated using Cox proportional hazards analysis. RESULTS: Among 9849 persons followed for a median of 19.0 years (range, 0.02-22.1), the cumulative incidence of CLD was 1.4%. In multivariate analysis, participants who drank >2 cups per day had less than half the rate of CLD as those who drank <1 cup per day (hazard ratio, 0.43, 95% confidence interval: 0.24-0.78). Protection by coffee and tea was limited to persons at higher risk for liver diseases from heavier alcohol intake, overweight, diabetes, or high iron saturation. Among 9650 participants who provided detailed drink information in 1982-1984, intake of regular ground coffee and of caffeine was associated with lower incidence of CLD. CONCLUSIONS: Coffee and tea drinking decreases the risk of clinically significant CLD.     

Hepatitis C virus genotypes and viral concentrations in participants of a general population survey in the United States

BACKGROUND & AIMS: Estimates of the long-term benefits of antiviral therapies for chronic hepatitis C are influenced by the frequency of characteristics that affect response in the population treated. This study determined hepatitis C virus (HCV) genotypes and RNA titers among HCV-infected persons in the general population of the United States. METHODS: Genotypes were determined from the NS5b region, and HCV RNA was quantified by using Amplicor Monitor (Roche Diagnostic Systems, Inc, Branchburg, NJ) from 275 HCV RNA-positive participants in the Third National Health and Nutrition Examination Survey conducted during 1988 to 1994. RESULTS: The HCV genotypes identified included 1a (n = 142), 1b (n = 73), 2a (n = 8), 2b (n = 27), 3a (n = 17), 4 (n = 3), and 6 (n = 5). Based on weighted analysis of persons infected with genotypes 1, 2, and 3, genotype 1 predominated in all age groups (75.3%). By racial/ethnic group, genotype 1 was found in 90.9% of non-Hispanic blacks, 69.6% of non-Hispanic whites, and 71.2% of Mexican Americans. After adjusting for age and gender, only non-Hispanic black race/ethnicity was independently associated with genotype 1 infection (adjusted odds ratio 4.9; 95% confidence interval, 1.9-12.8). The overall geometric mean concentration of HCV RNA was 2.1 x 10(6) IU/mL; concentrations > 2 million IU/mL were found in 53.0% overall and 50.3% of persons with genotype 1. CONCLUSIONS: Persons with chronic hepatitis C in the United States who may require treatment in the foreseeable future are predominantly infected with genotype 1, including a disproportionate number of non-Hispanic blacks. These features emphasize the need for improved therapies that reduce or eliminate complications from genotype 1 infections.     

Relation of elevated serum alanine aminotransferase activity with iron and antioxidant levels in the United States

BACKGROUND & AIMS: Oxidative stress is thought to play a role in liver injury. Hepatic iron may promote liver injury, whereas antioxidant vitamins and minerals may inhibit it, but few clinical studies have examined such relationships. We analyzed the associations of serum iron measures and antioxidant concentrations with abnormal serum alanine transaminase (ALT) activity in a large, national, population-based study. METHODS: A total of 13,605 adult participants in the third U.S. National Health and Nutrition Examination Survey (NHANES III), 1988-1994, underwent phlebotomy. Exclusions included excessive alcohol consumption, hepatitis B and C, and iron overload. RESULTS: Elevated ALT levels were found in 3.1% of the population. In univariate analysis, factors associated with abnormal ALT levels (P < 0.05) included higher transferrin saturation and iron and selenium concentrations, and lower vitamin C, alpha and beta carotene, and lutein/zeaxanthin concentrations. In multivariate logistic regression analyses, elevated ALT level was associated positively with increasing deciles of transferrin saturation (odds ratio [OR] per decile, 1.10; 95% confidence interval [CI], 1.03-1.18) and iron concentration (OR, 1.13; 95% CI, 1.06-1.21). Abnormal ALT level was associated negatively with increasing deciles of alpha carotene (OR, 0.82; 95% CI, 0.72-0.94), beta carotene (OR, 0.91; 95% CI, 0.86-0.96), beta cryptoxanthin (OR, 0.91; 95% CI, 0.84-0.99), lutein/zeaxanthin (OR, 0.90; 95% CI, 0.84-0.96), and a variable combining the 5 carotenoid measures (OR, 0.89; 95% CI, 0.83-0.95). Vitamin C was associated inversely, but only at the highest concentrations. CONCLUSIONS: In this large, national, population-based study, the risk for apparent liver injury was associated with increased iron and decreased antioxidants, particularly carotenoids.     

International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom,Sweden, and the United States: The MINAP/NICOR,SWEDEHEART/RIKS-HIA,and ACTION Registry-GWTG/NCDR registries

Objectives

To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries.

Background

Results from clinical trials suggest significant variation in care across the world. However, international comparisons in “real world” registries are limited.

Methods

We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n = 137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n = 45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n = 147,438] clinical registries.

Results

Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%).

Conclusions

The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.