Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2023; 15(2): 289-302
Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.289
Racial and gender-based disparities and trends in common psychiatric conditions in liver cirrhosis hospitalizations: A ten-year United States study
Pratik Patel, Hassam Ali, Faisal Inayat, Rahul Pamarthy, Alexa Giammarino, Fariha Ilyas, Lucia Angela Smith-Martinez, Sanjaya K Satapathy
Pratik Patel, Department of Gastroenterology, Mather Hospital and Hofstra University Zucker School of Medicine, Port Jefferson, NY 11777, United States
Hassam Ali, Rahul Pamarthy, Fariha Ilyas, Department of Internal Medicine, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
Faisal Inayat, Department of Internal Medicine, Allama Iqbal Medical College, Lahore 54550, Punjab, Pakistan
Alexa Giammarino, Department of Internal Medicine, North Shore University Hospital and Hofstra University Zucker School of Medicine, Port Jefferson, NY 11777, United States
Lucia Angela Smith-Martinez, Department of Psychiatry, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
Sanjaya K Satapathy, Department of Hepatology, North Shore University Hospital and Hofstra University Zucker School of Medicine, Manhasset, NY 11030, United States
Author contributions: Patel P, Ali H, Inayat F, Pamarthy R, and Giammarino A contributed to conceptualization, methodology, software, data curation, validation, writing, and original draft preparation; Ilyas F and Smith-Martinez LA contributed to writing, reviewing, editing, and supervision; Satapathy SK project administration, supervision, and critical revision of the manuscript; all authors had access to the study data and reviewed and approved the final manuscript.
Institutional review board statement: Patients’ data was not acquired by any specific institution but rather open-access United States National Inpatient Sample (NIS) data. The NIS contains de-identified information, protecting the privacy of patients, physicians, and hospitals. Therefore, it was deemed exempt from the institutional review board (IRB).
Informed consent statement: Participants were not required to give informed consent for this retrospective study since the analysis of baseline characteristics used anonymized clinical data.
Conflict-of-interest statement: There is no conflict of interest associated with publication of this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hassam Ali, MD, Research Scientist, Department of Internal Medicine, East Carolina University Brody School of Medicine, 600 Moye Blvd, Greenville, NC 27834, United States. alih20@ecu.edu
Received: October 17, 2022
Peer-review started: October 17, 2022
First decision: December 24, 2022
Revised: January 1, 2023
Accepted: January 31, 2023
Article in press: January 31, 2023
Published online: February 27, 2023
Processing time: 129 Days and 18.4 Hours
Abstract
BACKGROUND

Chronic liver disease is associated with various neuropsychiatric conditions. There are currently no large studies assessing and comparing the prevalence of psychiatric illnesses based on patient profiles and the etiology of cirrhosis.

AIM

To examine the trends of hospitalizations among psychiatric conditions in cirrhosis.

METHODS

We used the National Inpatient Sample database 2009-2019 for the primary diagnosis of liver cirrhosis. The outcomes included the prevalence, trends, and associations of psychiatric diagnoses in these hospitalizations. Chi-square for categorical variables and the Wilcoxon rank test for continuous variables were utilized.

RESULTS

The prevalence of generalized anxiety disorder (GAD) in liver cirrhosis hospitalizations increased from 0.17% in 2009 to 0.92% in 2019 (P < 0.001). The prevalence of depression increased from 7% in 2009 to 12% in 2019 (P < 0.001). Attention deficit hyperactivity disorder (ADHD) prevalence increased from 0.06% to 0.24%. The prevalence of schizophrenia increased from 0.59% to 0.87% (P < 0.001). Schizoaffective disorder prevalence increased from 0.10% to 0.35% (P < 0.001). Post-traumatic stress disorder (PTSD) prevalence displayed increasing trends from 0.36% in 2009 to 0.93% in 2019 (P < 0.001). The prevalence of suicidal ideation increased from 0.23% to 0.56% in 2019. Cirrhosis related to alcoholic liver disease [adjusted odds ratios (aOR) 1.18, 95%CI 1.08-1.29, P < 0.001] and non-alcoholic fatty liver disease (NAFLD) (aOR 1.14, 95%CI 1.01-1.28, P = 0.025) was associated with depression more than other causes. Alcohol- and NAFLD-associated cirrhosis had a stronger link to psychiatric disorders. Females had a higher association with GAD (aOR 2.56, 95%CI 2.14-3.06, P < 0.001), depression (aOR 1.78, 95%CI 1.71-1.84, P < 0.001), bipolar disorder (aOR 1.64, 95%CI 1.52-1.77, P < 0.001] and chronic fatigue (aOR 2.31, 95%CI 1.31-4.07, P < 0.001) when compared to males. Blacks, Hispanics, and Asian/Native Americans had a significantly lower association with GAD, depression, bipolar disorder, PTSD, and ADHD when compared to the white race.

CONCLUSION

The prevalence of psychiatric comorbidities in liver cirrhosis hospitalizations has increased over the last decade. Females had a higher association with psychiatric disorders compared to males. Blacks, Hispanics, and Asian/Native Americans had lower associations with psychiatric comorbidities compared to the white race.

Keywords: Liver cirrhosis hospitalizations; Psychiatric conditions; Racial and gender disparities

Core Tip: Currently, large studies assessing and comparing the prevalence of psychiatric conditions based on patient profiles and the etiology of cirrhosis are lacking in the published literature. In this National Inpatient Sample-based retrospective study, we aimed to assess the trends of hospitalizations among psychiatric conditions in cirrhosis. Our findings highlight the disparities in the diagnoses of certain psychiatric conditions in cirrhotics between gender and race. It is pertinent to recognize these disparities, as doing so may expedite management and improve overall outcomes. Therefore, all patients with cirrhosis should be provided with a referral to a mental health professional at the time of diagnosis.