Influence of substance use on rising hepatitis A hospitalizations in the United States: A decade-long comparative study

Table 1 Demographic characteristics of patients hospitalised for hepatitis A in the United States from 2011-2020, n (%)

Characteristics	Total	No drug use	Active substance use
Number of hospitalizations	55933	40503	15430
Mean age, years (SE)	49.39 (0.09)	53.47 (0.09)	38.68 (0.09)
Age groups, years
18-34	13553 (24.23)	7200 (17.78)	6353 (41.17)
35-49	14616 (26.13)	8541 (21.09)	6075 (39.37)
50-64	14920 (26.67)	12233 (30.20)	2687 (17.41)
65-79	9736 (17.41)	9426 (23.27	310 (2.01)
≥ 80	3108 (5.56)	3103 (7.66)	5 (0.03)
Gender
Male	30805 (55.09)	21072 (52.05)	9733 (63.08)
Female	25109 (44.91)	19412 (47.95)	5697 (36.92)
Race
White	40359 (74.68)	27701 (71.00)	12658 (84.27)
Black	4798 (8.88)	3680 (9.43)	1118 (7.44)
Hispanic	5480 (10.14)	4704 (12.06)	776 (5.17)
Asian or Pacific Islander	1241 (2.30)	1200 (3.08)	41 (0.27)
Native Americans	2161 (4.00)	1733 (4.44)	428 (2.85)
Hospital region
Northeast	8602 (15.38)	6944 (17.14	1658 (10.75)
Midwest	10371 (18.54)	7474 (18.45)	2897 (18.78)
South	28701 (51.31)	19527 (48.21)	9174 (59.46)
West	8259 (14.77)	6558 (16.19)	1701 (11.02
Hospital location and teaching status
Rural	5514 (9.87)	3959 (9.79)	1555 (10.08)
Urban non-teaching	12813 (22.93)	9822 (24.28)	2991 (19.39)
Urban teaching	37548 (67.20)	26668 (65.93)	10880 (70.53)
Discharge against medical advice	2882 (5.20)	1003 (2.50)	1879 (12.27)

Table 2 Overall trends of outcomes in patients hospitalized for hepatitis A virus in the United States from 2011-2020, n (%)

Unmatched hepatitis A virus
Variable	No substance use	Active substance use	Total
Number of hospitalizations	40503	15430	56972
Inpatient mortality	396 (0.98)	100 (0.65)	496 (0.87)
Mean LOS, days (SE)	4.22 (0.02)	4.27 (0.05)	4.23 (0.02)
Inflation-adjusted mean inpatient charge, United States dollar (SE)	13440.49 (88.45)	9280.17 (103.62)	12299.86 (70)
Infective endocarditis	59 (0.15)	250 (1.62)	309 (0.54)
Intra-abdominal abscess	188 (0.46)	40 (0.26)	238 (0.42)
Sepsis	353 (0.87)	265 (1.72)	618 (1.08)
Acute liver failure	2666 (6.58)	1177 (7.63)	3893 (6.83)
AKI	3820 (9.43)	928 (6.01)	4763 (8.36)
Respiratory failure	933 (2.30)	245 (1.59)	1193 (2.09)
Blood transfusion	670 (1.65)	60 (0.39)	740 (1.30)
Cellulitis	806 (1.99)	904 (5.86)	1725 (3.03)
Venous thromboembolism	117 (0.29)	25 (0.16)	142 (0.25)
Cardiomyopathy	744 (1.84)	190 (1.23)	934 (1.64)
CHF	2091 (5.16)	314 (2.03)	2405 (4.22)
Propensity score matched hepatitis A in 13079 patients
Variable	No substance use	Active substance use	P value
Inpatient mortality	94 (0.72)	100 (0.76)	0.6
Mean LOS, days (SE)	3.97 (0.04)	4.34 (0.05)	< 0.001
Inflation-adjusted mean inpatient charge, United States dollar (SE)	10417.43 (129.44)	9521.75 (103.53)	< 0.001
Infective endocarditis	20 (0.15)	188 (1.44)	< 0.001
Intra-abdominal abscess	66 (0.50)	40 (0.31)	0.011
Sepsis	129 (0.99)	243 (1.86)	< 0.001
Acute liver failure	900 (6.88)	992 (7.58)	0.028
AKI	883 (6.75)	824 (6.30)	0.140
Acute respiratory failure	267 (2.04)	224 (1.71)	0.050
Need for blood transfusion	166 (1.27)	55 (0.42)	< 0.001
Cellulitis	267 (2.04)	750 (5.73)	< 0.001
Venous thromboembolism	10 (0.08)	20 (0.15)	0.068
Cardiomyopathy	101 (0.77)	180 (1.38)	< 0.001
Congestive heart failure	219 (1.67)	304 (2.32)	< 0.001

AKI: Acute kidney injury; CHF: Congestive heart failure; LOS: length of stay.

Table 3 Predictors of inpatient mortality for substance use in hospitalisations for hepatitis A in the United States from 2011-2020

Predictors of inpatient mortality	Adjusted odds ratio	95%CI	P value
Female	0.99	0.78-1.25	0.945
Race
Black	0.46	0.26-0.78	0.004
Hispanic	1.39	0.93-2.08	0.108
Asian or Pacific Islander	1.24	0.60-2.56	0.555
Native Americans	0.63	0.27-1.42	0.268
Elixhauser comorbidity index	2.43	1.80-3.26	0.000
Hospital region
Midwest	0.49	0.31-0.74	0.001
South	0.81	0.57-1.13	0.225
West	0.77	0.50-1.18	0.231
Hospital Bed-size
Medium	0.48	0.32-0.71	0.000
Large	0.61	0.43-0.83	0.002
Hospital location and teaching status
Urban non-teaching	1.36	0.84-2.18	0.211
Urban teaching	0.79	0.50-1.23	0.306
Comorbidities
Diabetes mellitus	0.72	0.53-0.97	0.034
Depression	1.31	0.98-1.75	0.065
Hypertension	1.42	1.10-1.82	0.007
Metaphase I	2.14	1.28-3.54	0.003
Cardiomyopathy	0.87	0.47-1.59	0.650
congestive heart failure	1.69	1.14-2.48	0.008
Afib	1.42	0.91-2.21	0.117
Dyslipidemia	0.67	0.49-0.90	0.010
Acquired anemia	1.03	0.79-1.32	0.821
Peripheral arterial disease	1.98	1.36-2.86	0.000
Chronic kidney disease	0.99	0.70-1.41	0.978
Chronic obstructive pulmonary disease	0.69	0.49-0.97	0.038
Malnutrition	1.07	0.72-1.56	0.736
Sepsis	5.10	3.61-7.20	0.000
Acute liver failure	6.22	4.88-7.91	0.000
acute kidney injury	2.78	2.11-3.64	0.000
Acute respiratory failure	30.02	22.9-39.2	0.000