Disparities in Outcomes of Alcohol-Associated Hepatitis in the United States: Insights from the National Inpatient Sample, 2016-2022.

BACKGROUND AND

aimsAlcohol-associated hepatitis (AH) is a severe manifestation of alcohol-associated liver disease with rising incidence, escalating costs, and persistently high short-term mortality. However, national data on how social determinants of health shape AH outcomes-and how these disparities evolved during the COVID-19 pandemic-remain limited. We aimed to characterize temporal trends in AH hospitalizations, mortality, and resource utilization in the United States, focusing on inequities by race, sex, payer, and geography.

methodsWe conducted a retrospective cohort study using the National Inpatient Sample (2016-2022), identifying adults ≥ 18 years hospitalized with a principal diagnosis of AH (ICD-10-CM K70.1). The primary outcome was in-hospital mortality; secondary outcomes were length of stay (LOS) and inflation-adjusted hospital charges. Exposures included race/ethnicity, income quartile, payer, hospital type, and region. Multivariable regression models adjusted for demographics, comorbidity burden (Weighted Elixhauser Comorbidity Score), and hospital characteristics. Interaction terms assessed disparities across the pre-COVID (2016-2019), early COVID (2020), and recovery (2021-2022) periods.

resultsAmong 907,390 weighted AH hospitalizations, median age was 48 years (IQR 38-57); 66% were male, and 52% resided in the lowest two income quartiles. Overall in-hospital mortality was 4.2%. Compared with White patients, mortality was higher among Native American (aOR 1.31), Hispanic (aOR 1.20), and Other race patients, and lower among Black patients (aOR 0.81). Compared with male sex, female sex (aOR 1.23) was independently associated with greater in-hospital mortality; Medicaid (aOR 1.28), private insurance (aOR 1.40), and self-pay (aOR 1.50) were each independently associated with greater mortality compared with Medicare. Mean LOS was 6.3 days, and median hospital charges were $36,533, with significantly higher costs among women, minority patients, and those admitted to urban teaching hospitals. During COVID-19, AH admissions and mortality rose disproportionately among Native American, Hispanic, and Asian/Pacific Islander populations, widening pre-existing inequities.

conclusionsAH is an expanding driver of liver-related hospitalizations in the United States, with outcomes strongly influenced by race, sex, payer, and geography. The COVID-19 pandemic exacerbated these disparities, disproportionately affecting underinsured and minority populations. Equity-focused interventions-Medicaid expansion, integrated hepatology-addiction care, and culturally tailored outreach-are urgently needed to reduce preventable mortality and costs.