Published online Jun 25, 2025. doi: 10.5501/wjv.v14.i2.97421
Revised: October 25, 2024
Accepted: November 22, 2024
Published online: June 25, 2025
Processing time: 389 Days and 10.3 Hours
Hepatitis A virus (HAV) infection remains the most common cause of acute viral hepatitis globally. In the United States, recent outbreaks have been attributed primarily to person-to-person transmission, with vulnerable populations such as people who use illicit drugs, those experiencing homelessness, and men who have sex with men disproportionately affected.
To assess the trends in HAV hospitalizations over the past decade and evaluate the impact of substance use on these hospitalizations.
We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2020. Adults (≥ 18 years) hospitalized with a primary diagnosis of HAV infection were included. We identified active substance use as a secondary diagnosis. Statistical analysis involved descriptive statistics, trend analysis, and propensity score matching to compare HAV hospitalizations with and without substance use. Outcomes included hospitalization trends, complications, length of stay (LOS), and mortality.
From 2011 to 2020, there were 56972 hospitalizations for HAV infections. Hospitalizations increased from 3917 in 2011 to 8290 in 2020, peaking at 9800 in 2018. Caucasian males (55%) were the most affected, with a mean age of 49 years. The prevalence of active substance use among HAV hospitalizations was 27%, with these patients being younger (mean age: 39 years) and predominantly male (63.1%). HAV hospitalizations associated with substance use increased significantly, rising from 235 cases in 2011 to 3200 in 2020 (P < 0.001). Compared to HAV hospitalizations without substance use, those with substance use had higher rates of co-infections (hepatitis C virus 45% vs 11%, hepatitis B virus 11% vs 6%) and complications, including sepsis (1.9% vs 1%) and infective endocarditis (1.4% vs 0.15%, P < 0.001). Hospitalizations with substance use also had longer LOS (4.34 days vs 3.97 days, P < 0.05), but mortality rates were comparable. Predictors of mortality in HAV-substance use hospitalizations included acute liver failure, sepsis, and acute respiratory failure.
HAV hospitalizations in the United States have significantly increased over the past decade, with the rise driven by cases involving substance use. These patients face a higher burden of complications and healthcare utilization. Tailored public health strategies, including targeted vaccination and outreach programs for at-risk populations, are essential to reduce the morbidity, mortality, and economic burden associated with HAV.
Core Tip: This study highlights the significant rise in hepatitis A virus (HAV) hospitalizations in the United States from 2011 to 2020, particularly among individuals with substance use disorders. Our findings indicate that younger males and Whites are disproportionately affected, with Southern states bearing the majority of the hospitalization burden. Notably, patients with substance use had higher rates of severe complications, including infective endocarditis and sepsis. The study underscores the urgent need for targeted public health interventions and enhanced vaccination efforts to mitigate the healthcare and economic impacts of HAV, especially among high-risk populations.