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Increasing prevalence of cirrhosis among insured adults in the United States, 2012–2018

Ladner, Daniela P., Gmeiner, Michael ORCID: 0000-0002-9604-4061, Hasjim, Bima J., Mazumder, Nikhilesh, Kang, Raymond, Parker, Emily, Stephen, John, Polineni, Praneet, Chorniy, Anna, Zhao, Lihui, VanWagner, Lisa B., Ackermann, Ronald T. and Manski, Charles F. (2024) Increasing prevalence of cirrhosis among insured adults in the United States, 2012–2018. PLOS ONE, 19 (2). ISSN 1932-6203

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Identification Number: 10.1371/journal.pone.0298887


Background Liver cirrhosis is a chronic disease that is known as a “silent killer” and its true prevalence is difficult to describe. It is imperative to accurately characterize the prevalence of cirrhosis because of its increasing healthcare burden. Methods In this retrospective cohort study, trends in cirrhosis prevalence were evaluated using administrative data from one of the largest national health insurance providers in the US. (2011–2018). Enrolled adult (≥18-years-old) patients with cirrhosis defined by ICD-9 and ICD-10 were included in the study. The primary outcome measured in the study was the prevalence of cirrhosis 2011–2018. Results Among the 371,482 patients with cirrhosis, the mean age was 62.2 (±13.7) years; 53.3% had commercial insurance and 46.4% had Medicare Advantage. The most frequent cirrhosis etiologies were alcohol-related (26.0%), NASH (20.9%) and HCV (20.0%). Mean time of follow-up was 725 (±732.3) days. The observed cirrhosis prevalence was 0.71% in 2018, a 2-fold increase from 2012 (0.34%). The highest prevalence observed was among patients with Medicare Advantage insurance (1.67%) in 2018. Prevalence increased in each US. state, with Southern states having the most rapid rise (2.3-fold). The most significant increases were observed in patients with NASH (3.9-fold) and alcohol-related (2-fold) cirrhosis. Conclusion Between 2012–2018, the prevalence of liver cirrhosis doubled among insured patients. Alcohol-related and NASH cirrhosis were the most significant contributors to this increase. Patients living in the South, and those insured by Medicare Advantage also have disproportionately higher prevalence of cirrhosis. Public health interventions are important to mitigate this concerning trajectory of strain to the health system.

Item Type: Article
Official URL:
Additional Information: © 2024 The Authors
Divisions: Economics
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine
Date Deposited: 08 Mar 2024 17:12
Last Modified: 16 May 2024 13:45

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